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Individual

MICHAEL WILLIAM EARLEY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M. D.

Contact information

Practice address
3623 W CHICAGO AVE, CHICAGO, IL 60651-3934
(773) 722-6171
(773) 722-7913
Mailing address
3623 W CHICAGO AVE, CHICAGO, IL 60651-3934
(773) 722-6171
(773) 722-7913

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036067635
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
036067635
IL
Enumeration date
09/22/2006
Last updated
07/09/2007
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