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NPI Code Detail

MEDICARE: ALAN MICCO MD

MEDICARE: ALAN MICCO MD
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
1207Y00000XOtolaryngology Physician036079904IL
2207YX0901XOtology & Neurotology Physician036-079904IL

General Provider Information

NPI Number : 1861426223
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALAN MICCO MD
Provider Business Mailing Address
First Line : 675 N SAINT CLAIR ST STE 15-200
Second Line :
City : CHICAGO
State : IL
Zip : 60611-5967
Country : US
Telephone Number : 312-695-8182
Fax Number : 312-695-4303
Provider Business Practice Location Address
First Line : 675 N SAINT CLAIR ST STE 15-200
Second Line :
City : CHICAGO
State : IL
Zip : 60611-5967
Country : US
Telephone Number : 312-695-8182
Fax Number : 312-695-4303
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/10/2006
Last Update Date : 06/13/2022

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Directions to “ ALAN MICCO MD” Practice Location

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