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General NPI Number Information
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NPI Number | 1487150629
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Entity Type | Individual
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Provider Name | MICHAEL MESIROW PA-C
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Gender | Male
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Dates
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Enumeration Date | 04/05/2018
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Last Update Date | 03/05/2025
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Provider Practice Location Address
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Address Line | 2550 OAK PARK AVE
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City | BERWYN
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State | IL
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Zip | 60402-4661
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Country | US
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Telephone | 708-575-6757
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Fax |
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Provider Business Mailing Address
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Address Line | 618 PADDOCK LN
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City | LIBERTYVILLE
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State | IL
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Zip | 60048-3733
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Country | US
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Telephone | 773-504-7075
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 085.006505
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License Number State | IL
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