MEDICARE: DR. KATE LYNN MAXOURIS M.D.

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	207Q00000X	Family Medicine Physician	036-093187	IL

General Provider Information

NPI Number	:	1215986062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATE LYNN MAXOURIS M.D.

Provider Business Mailing Address
First Line	:	5140 N CALIFORNIA AVE
Second Line	:	SUITE 635/645
City	:	CHICAGO
State	:	IL
Zip	:	60625-3645
Country	:	US
Telephone Number	:	773-878-8200
Fax Number	:	773-878-0788

Provider Business Practice Location Address
First Line	:	5140 N CALIFORNIA AVE
Second Line	:	SUITE 635/645
City	:	CHICAGO
State	:	IL
Zip	:	60625-3645
Country	:	US
Telephone Number	:	773-878-8200
Fax Number	:	773-878-0788

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

Provider Enumeration Date	:	05/09/2006
Last Update Date	:	07/21/2022

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