D/b/a Kirkland Medical Clinic | |
406 South 5th Street Kirkland IL 60146 | |
(815) 522-3301 | |
(815) 522-3855 |
Full Name | D/b/a Kirkland Medical Clinic |
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Speciality | General Practice |
Location | 406 South 5th Street, Kirkland, Illinois |
Authorized Official Name and Position | Thomas L Michalsen (PRESIDENT) |
Authorized Official Contact | 8155223301 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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D/b/a Kirkland Medical Clinic 406 South 5th Street Kirkland IL 60146 Ph: (815) 522-3301 | D/b/a Kirkland Medical Clinic 406 South 5th Street Kirkland IL 60146 Ph: (815) 522-3301 |
NPI Number | 1841214368 |
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Provider Enumeration Date | 07/27/2006 |
Last Update Date | 08/22/2022 |
Medicare PECOS PAC ID | 3274609672 |
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Medicare Enrollment ID | O20080909000518 |
Identifier | Type | State | Issuer |
---|---|---|---|
1841214368 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 036096167 (Illinois) | Secondary |
208D00000X | General Practice | 036066772 (Illinois) | Primary |
Provider Name | Thomas Michalsen |
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Provider Type | Practitioner - General Practice |
Provider Identifiers | NPI Number: 1114947876 PECOS PAC ID: 9739156043 Enrollment ID: I20080718000036 |
Provider Name | Cathy L Carlson |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1225431653 PECOS PAC ID: 4880983378 Enrollment ID: I20221013003459 |