Individual
DR. MICHAEL POURTABIB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
100 SPALDING DR, SUITE 102, NAPERVILLE, IL 60540-6550
(630) 355-5860
Mailing address
1035 SNOWDON CT, NAPERVILLE, IL 60540-8251
(630) 420-1820
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2215455
BLUE CROSS
IL
Enumeration date
07/28/2006
Last updated
07/09/2007
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