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NPI Code Detail

MEDICARE: MICHAEL KIRK SUBTELNY DMD

MEDICARE: MICHAEL KIRK SUBTELNY DMD
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
11223G0001XGeneral Practice Dentistry019.031632IL

General Provider Information

NPI Number : 1952894248
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL KIRK SUBTELNY DMD
Provider Business Mailing Address
First Line : 4401 W LAWRENCE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60630-2510
Country : US
Telephone Number : 773-725-6086
Fax Number :
Provider Business Practice Location Address
First Line : 4401 W LAWRENCE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60630-2510
Country : US
Telephone Number : 773-725-6086
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/11/2018
Last Update Date : 03/18/2021

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