MEDICARE: MICHAEL OLIPHANT L.AC.

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	171100000X	Acupuncturist	198000983	IL

General Provider Information

NPI Number	:	1366702953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL OLIPHANT L.AC.

Provider Business Mailing Address
First Line	:	4770 N LINCOLN AVE STE 212
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-2092
Country	:	US
Telephone Number	:	312-869-9654
Fax Number	:

Provider Business Practice Location Address
First Line	:	4770 N LINCOLN AVE STE 212
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-2092
Country	:	US
Telephone Number	:	312-869-9654
Fax Number	:

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

Provider Enumeration Date	:	05/17/2012
Last Update Date	:	04/26/2023

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