Provider Demographics
NPI:1174800155
Name:NEVILLE, MICHAEL JOHN (DO)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOHN
Last Name:NEVILLE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1948 THREE FARMS AVE
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-1105
Mailing Address - Country:US
Mailing Address - Phone:630-527-1818
Mailing Address - Fax:630-527-1244
Practice Address - Street 1:1948 THREE FARMS AVE
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-1105
Practice Address - Country:US
Practice Address - Phone:630-527-1818
Practice Address - Fax:630-527-1244
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-04
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036135947207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine