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General NPI Number Information
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NPI Number | 1518300375
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Entity Type | Individual
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Provider Name | DAVID RALPH MICHAEL D.O.
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Gender | Male
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Dates
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Enumeration Date | 04/11/2013
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Last Update Date | 02/29/2024
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Provider Practice Location Address
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Address Line | 2334 W LAWRENCE AVE STE 221
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City | CHICAGO
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State | IL
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Zip | 60625-1030
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Country | US
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Telephone | 312-535-9614
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Fax | 312-535-8301
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Provider Business Mailing Address
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Address Line | 2337 W WOLFRAM ST APT 415
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City | CHICAGO
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State | IL
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Zip | 60618-8051
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Country | US
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Telephone | 312-535-9614
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Fax | 312-586-8301
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 63306-21
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 036144355
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License Number State | IL
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