Individual provider Active NPI

Michael A. Guthrie, D.D.S.

  • Oral and Maxillofacial Pathology Dentistry
  • Chicago, IL
National Provider Identifier
1063504819
Registry record updated Sep 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Pathology DentistryTaxonomy code 1223P0106X
License
019-024222 Issued in IL
Practice address
2300 S Michigan Ave Ste 100
Chicago, IL 60616-2119
Phone
(872) 302-5322
Fax
(872) 282-0337
NPI assigned
Sep 29, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 8, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Pathology Dentistry 1223P0106X 019-024222 IL Primary

Addresses

Primary practice location

2300 S Michigan Ave Ste 100
Chicago, IL 60616-2119

Mailing address

2300 S Michigan Ave Ste 100
Chicago, IL 60616-2119
Phone (872) 302-5322

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240412003454 IL Practitioner - Dentist 1456411354

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
019-024222ILMDOral and Maxillofacial Pathology Dentist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757289600000",
    "number": "1063504819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2300 S MICHIGAN AVE STE 100",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606162119",
            "telephone_number": "872-302-5322",
            "fax_number": "872-282-0337"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 S MICHIGAN AVE STE 100",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606162119",
            "telephone_number": "872-302-5322",
            "fax_number": "872-282-0337"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUTHRIE",
        "first_name": "MICHAEL",
        "middle_name": "A.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-29",
        "last_updated": "2025-09-08",
        "certification_date": "2025-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0106X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Pathology",
            "state": "IL",
            "license": "019-024222",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.