Provider Demographics
NPI:1699521195
Name:FERRER, MIGUEL E
Entity type:Individual
Prefix:
First Name:MIGUEL
Middle Name:E
Last Name:FERRER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6500 N GLENWOOD AVE APT 302
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-5154
Mailing Address - Country:US
Mailing Address - Phone:312-493-8546
Mailing Address - Fax:
Practice Address - Street 1:PROASSISTING INC, 18761 CHESTNUT CT, MOKENA
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-9501
Practice Address - Country:US
Practice Address - Phone:786-448-9020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-25
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL238000807363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical