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NPI Code Detail

MEDICARE: DR. MICHAEL CHARLES MENYHART DDS

MEDICARE: DR. MICHAEL CHARLES MENYHART DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry19A14629IL

General Provider Information

NPI Number : 1013123645
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHAEL CHARLES MENYHART DDS
Provider Business Mailing Address
First Line : 2812 FARMINGTON RD
Second Line :
City : NORTHBROOK
State : IL
Zip : 60062-6912
Country : US
Telephone Number : 847-564-2812
Fax Number :
Provider Business Practice Location Address
First Line : 1307 N RAND RD
Second Line :
City : ARLINGTON HTS
State : IL
Zip : 60004-4307
Country : US
Telephone Number : 847-392-4422
Fax Number : 847-392-4345
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/14/2007
Last Update Date : 07/08/2007

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