MEDICARE: MICHAEL SEVERINO MD

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
1	207RC0000X	Cardiovascular Disease Physician	036082780	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	206147059	OTHER	IL	MEDICARE PTAN (INDIVIDUAL)
2	206147	OTHER	IL	MEDICARE PTAN (GROUP)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174591531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL SEVERINO MD

Provider Business Mailing Address
First Line	:	25 N WINFIELD RD STE 500
Second Line	:
City	:	WINFIELD
State	:	IL
Zip	:	60190-1379
Country	:	US
Telephone Number	:	630-232-2800
Fax Number	:	630-232-3895

Provider Business Practice Location Address
First Line	:	25 N WINFIELD RD STE 500
Second Line	:
City	:	WINFIELD
State	:	IL
Zip	:	60190-1379
Country	:	US
Telephone Number	:	630-232-2800
Fax Number	:	630-232-3895

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2006
Last Update Date	:	08/02/2024

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Directions to “ MICHAEL SEVERINO MD” Practice Location

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