MEDICARE: MICHELLE SILVA

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	106S00000X	Behavior Technician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	138333638	OTHER	IL	BLUECROSS BLUESHIELD

General Provider Information

NPI Number	:	1730763319
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE SILVA

Provider Business Mailing Address
First Line	:	4137 W MARQUETTE RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60629-5145
Country	:	US
Telephone Number	:	773-430-4351
Fax Number	:

Provider Business Practice Location Address
First Line	:	4137 W MARQUETTE RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60629-5145
Country	:	US
Telephone Number	:	773-430-4351
Fax Number	:

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

Provider Enumeration Date	:	05/10/2021
Last Update Date	:	05/10/2021

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Directions to “ MICHELLE SILVA ” Practice Location

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