Provider Demographics
NPI:1427619006
Name:CONSALVO, MICHAEL ANTHONY (ASSOCIATE)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ANTHONY
Last Name:CONSALVO
Suffix:
Gender:M
Credentials:ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:462 ROOSEVELT RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-5611
Mailing Address - Country:US
Mailing Address - Phone:630-469-6061
Mailing Address - Fax:630-469-1212
Practice Address - Street 1:75 MARKET ST STE 9
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-5061
Practice Address - Country:US
Practice Address - Phone:630-469-6061
Practice Address - Fax:630-469-1212
Is Sole Proprietor?:No
Enumeration Date:2019-06-25
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3361237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist