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NPI Code Detail

MEDICARE: DR. MICHAEL R DEHAAN M.D.

MEDICARE: DR. MICHAEL R DEHAAN 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
1208600000XSurgery Physician036073579IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00213432OTHERILRRMC
20001635157OTHERILBCBS PROVIDER NO.
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1770588287
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHAEL R DEHAAN M.D.
Provider Business Mailing Address
First Line : 401 N MICHIGAN AVE STE 1200
Second Line :
City : CHICAGO
State : IL
Zip : 60611-4264
Country : US
Telephone Number : 312-635-0973
Fax Number :
Provider Business Practice Location Address
First Line : 401 N MICHIGAN AVE STE 1200
Second Line :
City : CHICAGO
State : IL
Zip : 60611-4264
Country : US
Telephone Number : 312-635-0973
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/21/2005
Last Update Date : 07/28/2025

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