Basic Information
| Provider Information | |||||||||
| NPI: | 1093976250 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DIGGS | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | JOHANNES | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 106 S RIDGELAND AVE | ||||||||
| Address2: | #216 | ||||||||
| City: | OAK PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 603024613 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3122317980 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2160 SOUTH FIRST AVE | ||||||||
| Address2: | DEPT OF ANESTHESIOLOGY | ||||||||
| City: | MAYWOOD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60153 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7082169000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2008 | ||||||||
| LastUpdateDate: | 06/20/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 036119088 | IL | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.