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General NPI Number Information
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NPI Number | 1831575687
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Entity Type | Individual
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Provider Name | MICHAEL REGAN PA-C
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Gender | Male
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Dates
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Enumeration Date | 08/04/2015
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Last Update Date | 05/01/2019
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Provider Practice Location Address
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Address Line | 6685 FERNWOOD DR
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City | LISLE
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State | IL
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Zip | 60532-3419
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Country | US
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Telephone | 773-858-8828
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Fax |
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Provider Business Mailing Address
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Address Line | 680 N LAKE SHORE DR STE 1000
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City | CHICAGO
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State | IL
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Zip | 60611-8709
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Country | US
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Telephone |
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Fax | 630-495-1770
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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 | 085.005533
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License Number State | IL
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