Individual
MARIA MICHELE MICHELOTTI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2050 PFINGSTEN RD, SUITE 330, GLENVIEW, IL 60026-1324
(847) 998-4100
(847) 998-5837
Mailing address
2650 RIDGE AVE, EVANSTON HOSPITAL, EVANSTON, IL 60201-1718
(847) 570-1206
(847) 570-1248
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036-066505
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036-066505
—
IL
01
—
11028928
RAILROAD MEDICARE
IL
01
—
1620385
BCBS PPO
IL
Enumeration date
11/28/2006
Last updated
10/06/2020
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