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Organization
MICHAEL G CLOSE MD PC
Active
Organization
MICHAEL G CLOSE MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES MIEDEMA (MANAGER)
(773) 243-0010
Entity
Organization
Contact information
Practice address
5137 N BROADWAY ST, CHICAGO, IL 60640-3009
(773) 243-0010
(773) 243-0015
Mailing address
5137 N BROADWAY ST, CHICAGO, IL 60640-3009
(773) 243-0010
(773) 243-0015
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036086407
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036086407
—
IL
01
—
1622969
BCBS
IL
Enumeration date
01/07/2009
Last updated
01/07/2009
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