Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Paulo Roberto Kossatz Michelini

Individual provider Family Medicine Physician · NPI 1164916706

Paulo Roberto Kossatz Michelini is a Family Practice in Peoria, Illinois. Qualified in 2018, 8 years ago. Practices with Prairie Du Chien Memorial Hospital Association Inc, a 49-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Illinois.

Years since qualifying
8
Licensed in
IL
In the registry since
2018
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Practice location Address checks out

221 NE Glen Oak Ave
Peoria, IL 61636-0001
Phone: (309) 672-4974
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 815 Main St Ste C, Peoria, IL 61602-1080 — (309) 672-4977

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence 90200000X (IL)

Record details

NPI number1164916706
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedJune 18, 2018
Last updated in NPPESJune 18, 2018

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyFAMILY PRACTICE
Medical schoolOTHER
Graduated 2018 (8 years in practice)
Group practice Prairie Du Chien Memorial Hospital Association Inc — 49 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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