MEDICARE: MS. ASHLEY L MICHELSEN PA-C

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	363AS0400X	Surgical Physician Assistant

General Provider Information

NPI Number	:	1851675979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ASHLEY L MICHELSEN PA-C

Provider Business Mailing Address
First Line	:	550 W OGDEN AVE
Second Line	:
City	:	HINSDALE
State	:	IL
Zip	:	60521-3186
Country	:	US
Telephone Number	:	630-794-8671
Fax Number	:	630-794-8662

Provider Business Practice Location Address
First Line	:	4700 GILBERT AVE
Second Line	:	SUITE 52
City	:	WESTERN SPRINGS
State	:	IL
Zip	:	60558-1753
Country	:	US
Telephone Number	:	708-387-1737
Fax Number	:	708-387-1739

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

Provider Enumeration Date	:	10/07/2011
Last Update Date	:	03/30/2015

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