MEDICARE: KAYSIE ELIZABETH LINGO L.AC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	198000929	IL

General Provider Information

NPI Number	:	1063750701
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYSIE ELIZABETH LINGO L.AC.

Provider Business Mailing Address
First Line	:	70 E LAKE ST
Second Line	:	SUITE 630
City	:	CHICAGO
State	:	IL
Zip	:	60601-5959
Country	:	US
Telephone Number	:	773-370-0766
Fax Number	:

Provider Business Practice Location Address
First Line	:	70 E LAKE ST
Second Line	:	SUITE 630
City	:	CHICAGO
State	:	IL
Zip	:	60601-5959
Country	:	US
Telephone Number	:	773-370-0766
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2013
Last Update Date	:	01/30/2013

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