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NPI Code Detail

MEDICARE: MICHAEL SUBTELNY DMD, PLLC

MEDICARE: MICHAEL SUBTELNY DMD, 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
1261QD0000XDental Clinic/Center

General Provider Information

NPI Number : 1497331755
Entity Type Code : Organization
Provider Name (Legal Business Name) : MICHAEL SUBTELNY DMD, PLLC
Provider Business Mailing Address
First Line : 225 N COLUMBUS DR APT 2605
Second Line :
City : CHICAGO
State : IL
Zip : 60601-5245
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4401 W LAWRENCE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60630-2510
Country : US
Telephone Number : 773-725-6086
Fax Number :
Authorized Official
Title or Position : DENTIST
Name : DR. MICHAEL SUBTELNY
Credential : DMD
Telephone Number : 630-666-1332
Provider Enumeration Date : 03/18/2021
Last Update Date : 03/18/2021

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