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NPI Code Detail

MEDICARE: DR. MICHAEL JM RAFFIN PH.D.

MEDICARE: DR. MICHAEL JM RAFFIN PH.D.
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
1231H00000XAudiologistIL

General Provider Information

NPI Number : 1174525489
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHAEL JM RAFFIN PH.D.
Provider Business Mailing Address
First Line : 2021 S WOLF RD
Second Line : APT 308
City : HILLSIDE
State : IL
Zip : 60162-2118
Country : US
Telephone Number : 708-216-3821
Fax Number :
Provider Business Practice Location Address
First Line : 2160 S 1ST AVE
Second Line :
City : MAYWOOD
State : IL
Zip : 60153-3328
Country : US
Telephone Number : 708-216-3821
Fax Number : 708-216-2137
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2005
Last Update Date : 07/08/2007

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