MEDICARE: ORA STUDIOS

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	021002047	IL
2	1223G0001X	General Practice Dentistry	019024315	IL

General Provider Information

NPI Number	:	1467607556
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORA STUDIOS

Provider Business Mailing Address
First Line	:	1827 S MICHIGAN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-1601
Country	:	US
Telephone Number	:	312-328-9000
Fax Number	:	312-328-9009

Provider Business Practice Location Address
First Line	:	1827 S MICHIGAN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-1601
Country	:	US
Telephone Number	:	312-328-9000
Fax Number	:	312-328-9009

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	SUZANNA DJUKIC
Credential	:
Telephone Number	:	219-384-4031

Provider Enumeration Date	:	11/18/2008
Last Update Date	:	11/18/2008

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Directions to “ORA STUDIOS ” Practice Location

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