Individual
DR. MICHAEL CLARKSTON SOULT II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2160 S 1ST AVE, MAYWOOD, IL 60153
(708) 216-9000
Mailing address
251 E HURON ST, HOFHEIMER HALL SUITE 610, CHICAGO, IL 60611-2908
(312) 695-6107
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
036140186
IL
2086S0129X
Vascular Surgery Physician
036.140186
IL
2086S0129X
Vascular Surgery Physician
Primary
036140186
IL
Other
Enumeration date
06/23/2009
Last updated
03/31/2025
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