Michael J Davalle, MD

Primary specialty

Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X

License

036066312 Issued in IL

Practice address

2650 Warrenville Rd
Ste 280
Downers Grove, IL 60515

Phone

(630) 324-7916

Fax

(630) 324-7946

NPI assigned

Apr 21, 2006

Last updated

Feb 14, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Loyola University Physician Foundation

  • General Practice Physician
  • Maywood, IL
  • NPI 1235148891
  NPD (past)

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

{
    "created_epoch": "1145577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581638400000",
    "number": "1386600039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2650 WARRENVILLE RD",
            "address_2": "STE 280",
            "city": "DOWNERS GROVE",
            "state": "IL",
            "postal_code": "60515",
            "telephone_number": "630-324-7916",
            "fax_number": "630-324-7946"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2650 WARRENVILLE RD",
            "address_2": "STE 280",
            "city": "DOWNERS GROVE",
            "state": "IL",
            "postal_code": "60515",
            "telephone_number": "630-324-7916",
            "fax_number": "630-324-7946"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVALLE",
        "first_name": "MICHAEL",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-21",
        "last_updated": "2020-02-14",
        "certification_date": "2020-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "IL",
            "license": "036066312",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "IN",
            "license": "01055379A",
            "primary": false
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "IN",
            "license": "01055379A",
            "primary": false
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "IL",
            "license": "036066312",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DU PAGE GROUP",
            "identifier": "344390",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COOK GROUP",
            "identifier": "526620",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "36066316",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• James B Danziger, OTR/L
• Klaudia Darlak
• Mateusz Witold Darlak
• Libby Jordan Dart, SLP
• Behnam Darvishan, DMD
• Jamie Davidson
• Sarah Davidson, LPC
• Alexa Davis
• Keely Davis
• Kenneth Paul Davison, PSY.D.

• Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician in Downers Grove, IL
• Providers in Downers Grove, IL by specialty
• Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.