MEDICARE: MS. HEATHER MICHELLE TARASKIEWICZ MT

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	:	1235350810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. HEATHER MICHELLE TARASKIEWICZ MT

Provider Business Mailing Address
First Line	:	2213 W. BELDEN AVE.
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647
Country	:	US
Telephone Number	:	773-519-1573
Fax Number	:

Provider Business Practice Location Address
First Line	:	2213 W. BELDEN AVE.
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647
Country	:	US
Telephone Number	:	773-519-1573
Fax Number	:

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

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	07/08/2007

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