MEDICARE: DR. MICHAEL ANGELO CARRANZA

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	183500000X	Pharmacist	051.306163	IL

General Provider Information

NPI Number	:	1912757683
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL ANGELO CARRANZA

Provider Business Mailing Address
First Line	:	3665 LEE AVE
Second Line	:
City	:	GURNEE
State	:	IL
Zip	:	60031-5429
Country	:	US
Telephone Number	:	224-627-2525
Fax Number	:

Provider Business Practice Location Address
First Line	:	6509 GRAND AVE
Second Line	:
City	:	GURNEE
State	:	IL
Zip	:	60031-1643
Country	:	US
Telephone Number	:	847-855-1991
Fax Number	:

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

Provider Enumeration Date	:	03/25/2024
Last Update Date	:	03/25/2024

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