Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 036147079 | IL |
N | 207X00000X | Orthopaedic Surgeon | 2017-00214 | NC |
N | 207XS0117X | Orthopaedic Spine Surgeon | 036147079 | IL |
NPI | 1386900652 |
---|---|
Provider Name | Dr. Michael Robert Conti Mica |
First Address | Chicago, IL 60674-2290 |
Second Address | Naperville, IL 60540-6559 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2012 |
Last Update Date | 27/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0397730004 | NSC# (01) | NC |
1386900652 | (05) | NC |
2017-00214 | MEDICAL LICENSE (01) | NC |
NC3013 | (05) | SC |