Individual
MICHELE AGNEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
408 S LOMBARD AVE, UNIT 2, OAK PARK, IL 60302-4244
(773) 383-0475
Mailing address
408 S LOMBARD AVE, UNIT 2, OAK PARK, IL 60302-4244
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
227.002148
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
168692
AMTA
IL
Enumeration date
12/14/2016
Last updated
12/14/2016
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