Individual
ETHAN MICHAEL MEISEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
211 E ONTARIO ST, SUITE 925, CHICAGO, IL 60611-3468
(312) 573-0614
(312) 573-0694
Mailing address
2001 BUTTERFIELD RD, SUITE 300, DOWNERS GROVE, IL 60515-1050
(630) 725-2832
(877) 489-5993
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
H95343
GA
208D00000X
General Practice Physician
Primary
036.123753
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
171006162A
—
GA
05
—
171006162B
—
GA
01
—
P01186845
MEDICARE RAILROAD INDIVIDUAL PTAN
IL
Enumeration date
08/31/2006
Last updated
05/20/2015
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