MEDICARE: DR. MICHAEL C RIVERA 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	207Q00000X	Family Medicine Physician	036108312	IL

General Provider Information

NPI Number	:	1447304282
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL C RIVERA MD

Provider Business Mailing Address
First Line	:	PO BOX 713260
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-1260
Country	:	US
Telephone Number	:	630-469-9200
Fax Number	:

Provider Business Practice Location Address
First Line	:	3310 W MAIN ST STE 100
Second Line	:
City	:	ST CHARLES
State	:	IL
Zip	:	60175-1024
Country	:	US
Telephone Number	:	630-377-2800
Fax Number	:	630-377-6774

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

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	07/17/2023

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