Organization
EPMG OF ILLINOIS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MIKE MIKHAIL M.D. (OFFICER)
(973) 251-1132
Entity
Organization
Contact information
Practice address
350 N WALL ST, KANKAKEE, IL 60901-2901
(469) 401-2386
Mailing address
5565 CENTERVIEW DR STE 107, RALEIGH, NC 27606-3563
(973) 251-1132
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
07223735
BC/BS OF ILLINOIS
IL
Enumeration date
07/03/2006
Last updated
07/31/2020
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