MEDICARE: LAURA M MIKHAIL M.D.

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	2080A0000X	Pediatric Adolescent Medicine Physician	036108530	IL

Other Identifiers

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

General Provider Information

NPI Number	:	1528067857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA M MIKHAIL M.D.

Provider Business Mailing Address
First Line	:	PO BOX 189
Second Line	:
City	:	MATTESON
State	:	IL
Zip	:	60443-0189
Country	:	US
Telephone Number	:	708-747-5850
Fax Number	:	708-747-9991

Provider Business Practice Location Address
First Line	:	1030 N CLARK ST
Second Line	:	SUITE 400
City	:	CHICAGO
State	:	IL
Zip	:	60610-5467
Country	:	US
Telephone Number	:	312-943-6964
Fax Number	:	312-943-6924

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

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	11/25/2009

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