MEDICARE: PRECISION EPILEPSY PLLC

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	2084N0400X	Neurology Physician

General Provider Information

NPI Number	:	1295482933
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRECISION EPILEPSY PLLC

Provider Business Mailing Address
First Line	:	1 E ERIE ST STE 525-4066
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-2740
Country	:	US
Telephone Number	:	833-530-3034
Fax Number	:	833-464-3529

Provider Business Practice Location Address
First Line	:	1 E ERIE ST STE 525-4066
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-2740
Country	:	US
Telephone Number	:	833-530-3034
Fax Number	:	833-464-3529

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOHN JOSEPH MILLICHAP
Credential	:	MD
Telephone Number	:	833-530-3034

Provider Enumeration Date	:	03/02/2022
Last Update Date	:	07/18/2024

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