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Individual

MICHAELA ELISE RICKERT

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
RD, PA-C

Contact information

Practice address
430 PENNSYLVANIA AVE # 320, GLEN ELLYN, IL 60137-4464
(630) 668-2180
Mailing address
1860 PAYSPHERE CIR, CHICAGO, IL 60674-0018
(630) 469-9200

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085005079
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1952686057
IL
Enumeration date
10/20/2011
Last updated
09/14/2018
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