MEDICARE: INFINITE HEALTH AND WELLNESS, LTD

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	261QM2500X	Medical Specialty Clinic/Center		IL

General Provider Information

NPI Number	:	1457543605
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INFINITE HEALTH AND WELLNESS, LTD

Provider Business Mailing Address
First Line	:	400 W HARRISON ST
Second Line	:	P.O. BOX 806338
City	:	CHICAGO
State	:	IL
Zip	:	60607-3902
Country	:	US
Telephone Number	:	773-582-6800
Fax Number	:

Provider Business Practice Location Address
First Line	:	4940 S CICERO AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60638-2116
Country	:	US
Telephone Number	:	773-582-6800
Fax Number	:

Authorized Official
Title or Position	:	M.D.
Name	:	DR. LORITZ M CHAVEZ
Credential	:
Telephone Number	:	773-582-6800

Provider Enumeration Date	:	08/13/2007
Last Update Date	:	08/13/2007

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