Basic Information
Provider Information
NPI: 1699030882
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SATZER
FirstName: MICHAEL
MiddleName: BENJAMIN
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 225 E CHICAGO AVE # 21
Address2:  
City: CHICAGO
State: IL
PostalCode: 606112991
CountryCode: US
TelephoneNumber: 3122274100
FaxNumber: 3122279640
Practice Location
Address1: 225 E CHICAGO AVE # 21
Address2:  
City: CHICAGO
State: IL
PostalCode: 606112991
CountryCode: US
TelephoneNumber: 3122274100
FaxNumber: 3122279640
Other Information
ProviderEnumerationDate: 07/12/2012
LastUpdateDate: 07/14/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/14/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2080P0202X036156258ILY Allopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology

No ID Information.


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