Individual
MICHAEL AGNICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1210 CROWN FOX LN, NEW LENOX, IL 60451-1205
(815) 320-3086
(815) 464-1767
Mailing address
PO BOX 367, FRANKFORT, IL 60423-0367
(815) 320-3086
(815) 464-1767
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
209-000590
IL
367500000X
Certified Registered Nurse Anesthetist
Primary
209000590
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
430075461
RAILROAD MEDICARE
IL
01
—
9932061
BLUE CROSS BLUE SHIELD
IL
Enumeration date
08/12/2006
Last updated
12/16/2025
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