MEDICARE: ROSA HAE S. CHOI M.D., S.C.

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	174400000X	Specialist		IL

General Provider Information

NPI Number	:	1164608881
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROSA HAE S. CHOI M.D., S.C.

Provider Business Mailing Address
First Line	:	6853 NORTH AVE
Second Line	:
City	:	OAK PARK
State	:	IL
Zip	:	60302-1023
Country	:	US
Telephone Number	:	708-383-3010
Fax Number	:

Provider Business Practice Location Address
First Line	:	6853 NORTH AVE
Second Line	:
City	:	OAK PARK
State	:	IL
Zip	:	60302-1023
Country	:	US
Telephone Number	:	708-383-3010
Fax Number	:

Authorized Official
Title or Position	:	ASST OFFICE MANAGER
Name	:	MS. ELIZABETH A WISER
Credential	:
Telephone Number	:	708-383-3010

Provider Enumeration Date	:	01/11/2008
Last Update Date	:	01/11/2008

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