Individual
MICHAEL J. PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
13011 S 104TH AVE STE 100, PALOS PARK, IL 60464-1508
(708) 274-3278
(708) 478-3299
Mailing address
13011 S 104TH AVE STE 100, PALOS PARK, IL 60464-1508
(708) 478-3600
(708) 478-3552
Taxonomy
Speciality
Code
Description
License number
State
207RC0001X
Clinical Cardiac Electrophysiology Physician
Primary
036104654
IL
207RC0001X
Clinical Cardiac Electrophysiology Physician
50709
CO
207RC0001X
Clinical Cardiac Electrophysiology Physician
A96097
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A960290
—
CA
05
—
55557007
—
CO
Enumeration date
06/22/2006
Last updated
12/10/2021
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