Individual
GEORGE E MIGUEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
210 N HAMMES AVE STE 108, JOLIET, IL 60435-6688
(815) 744-8977
(815) 744-8253
Mailing address
210 N HAMMES AVE STE 108, JOLIET, IL 60435-6688
(815) 744-8253
(815) 744-8977
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
036098565
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036098565
LICENSE #
IL
05
—
036098565
—
IL
01
—
09932095
BCBS PROVIDER #
IL
01
—
260050828
RR MEDICARE PROVIDER #
IL
Enumeration date
03/08/2006
Last updated
11/11/2021
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