MEDICARE: MICHAEL ANDREW PULTE APRN

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	363LF0000X	Family Nurse Practitioner	209033825	IL

General Provider Information

NPI Number	:	1770446569
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL ANDREW PULTE APRN

Provider Business Mailing Address
First Line	:	3110 N SHERIDAN RD APT 1210
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-4941
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3110 N SHERIDAN RD APT 1210
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-4941
Country	:	US
Telephone Number	:	616-970-3906
Fax Number	:

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

Provider Enumeration Date	:	12/08/2025
Last Update Date	:	12/08/2025

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