Individual
JOHN C MICHAEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
820 E TERRA COTTA AVE STE 247, CRYSTAL LAKE, IL 60014-3655
(815) 788-1000
(815) 788-2790
Mailing address
8780 W GOLF, SUITE 304, NILES, IL 60714
(847) 297-8900
(847) 297-8926
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
036088212
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036088212
LICENSE NUMBER
IL
05
—
0360882121
—
IL
01
—
0360882122
MEDICAID RETINALYSIS
IL
01
—
05626127
BLUE CROSS BLUE SHIELD GP
IL
01
—
180041333
RAILROAD MEDICARE
IL
01
—
DA3012
RAILROAD MEDICARE GROUP
IL
Enumeration date
08/23/2006
Last updated
07/17/2009
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