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NPI Code Detail

MEDICARE: MICHAEL E. FANELLI RN

MEDICARE: MICHAEL E. FANELLI RN
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
1363LA2200XAdult Health Nurse Practitioner209021539IL

General Provider Information

NPI Number : 1770106965
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL E. FANELLI RN
Provider Business Mailing Address
First Line : 4025 N SHERIDAN RD
Second Line :
City : CHICAGO
State : IL
Zip : 60613-2010
Country : US
Telephone Number : 773-388-1600
Fax Number :
Provider Business Practice Location Address
First Line : 4025 N SHERIDAN RD
Second Line :
City : CHICAGO
State : IL
Zip : 60613-2010
Country : US
Telephone Number : 773-388-1600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/21/2020
Last Update Date : 01/26/2026

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Directions to “ MICHAEL E. FANELLI RN” Practice Location

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