MEDICARE: DR. BERTRAM KRAFT 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	207W00000X	Ophthalmology Physician	3646407	IL

General Provider Information

NPI Number	:	1336132620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BERTRAM KRAFT M.D.

Provider Business Mailing Address
First Line	:	2251 BRACKEN LN
Second Line	:
City	:	NORTHFIELD
State	:	IL
Zip	:	60093-2902
Country	:	US
Telephone Number	:	847-441-9390
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 N WABASH AVE
Second Line	:	SUITE1610
City	:	CHICAGO
State	:	IL
Zip	:	60602-1903
Country	:	US
Telephone Number	:	312-263-6350
Fax Number	:	312-332-6341

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

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	11/06/2009

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