MEDICARE: DR. MICHAEL A DEVITO

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	213E00000X	Podiatrist	016-004558	IL

General Provider Information

NPI Number	:	1811920747
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL A DEVITO

Provider Business Mailing Address
First Line	:	1660 FEEHANVILLE DR STE 450
Second Line	:
City	:	MOUNT PROSPECT
State	:	IL
Zip	:	60056-6023
Country	:	US
Telephone Number	:	847-390-7666
Fax Number	:	708-425-6155

Provider Business Practice Location Address
First Line	:	10255 SOUTHWEST HWY
Second Line	:
City	:	CHICAGO RIDGE
State	:	IL
Zip	:	60415-1350
Country	:	US
Telephone Number	:	708-425-5656
Fax Number	:	708-425-6155

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

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	04/13/2022

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Directions to “ DR. MICHAEL A DEVITO ” Practice Location

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