Individual
DR. MICHAEL G LARRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M. D.
Contact information
Practice address
351 DELNOR DR STE 204, GENEVA, IL 60134-4226
(630) 653-4240
(630) 938-9190
Mailing address
351 DELNOR DR STE 204, GENEVA, IL 60134-4226
(630) 653-4240
(630) 938-9190
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
036-082779
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036082779
—
IL
01
—
206147215
MEDICARE PTAN (INDIVIDUAL)
IL
01
—
CA4748
MEDICARE RAILROAD PTAN (GROUP)
IL
01
—
P01185369
MEDICARE RAILROAD PTAN (INDIVIDUAL)
IL
Enumeration date
08/11/2006
Last updated
02/04/2020
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