Provider Demographics
NPI:1326219494
Name:MICHAEL M. MAGHRABI DPM, PC
Entity type:Organization
Organization Name:MICHAEL M. MAGHRABI DPM, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:MAGHRABI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:773-522-9700
Mailing Address - Street 1:2222 W DIVISION ST
Mailing Address - Street 2:105
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-2717
Mailing Address - Country:US
Mailing Address - Phone:773-862-3600
Mailing Address - Fax:
Practice Address - Street 1:2222 W DIVISION ST
Practice Address - Street 2:105
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-2717
Practice Address - Country:US
Practice Address - Phone:773-862-3600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5195100001Medicare NSC
ILU21980Medicare UPIN