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General NPI Number Information
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NPI Number | 1366269466
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Entity Type | Individual
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Provider Name | MICHAEL JASPER IGHO
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Gender | Male
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Dates
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Enumeration Date | 09/21/2024
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Last Update Date | 01/10/2025
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Provider Practice Location Address
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Address Line | 701 N 1ST ST
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City | SPRINGFIELD
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State | IL
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Zip | 62781-0001
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Country | US
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Telephone | 217-788-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 1715 SPARTAN DR
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City | CHATHAM
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State | IL
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Zip | 62629-8137
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Country | US
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Telephone | 217-361-9442
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 291077
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 209031001
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 041489427
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License Number State | IL
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