MEDICARE: DEMOREST CONSUTANTS LLC

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	036067738	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487895801
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEMOREST CONSUTANTS LLC

Provider Business Mailing Address
First Line	:	7255 W GRAND AVE
Second Line	:
City	:	ELMWOOD PARK
State	:	IL
Zip	:	60707-2028
Country	:	US
Telephone Number	:	440-279-0599
Fax Number	:	440-279-0593

Provider Business Practice Location Address
First Line	:	7255 W GRAND AVE
Second Line	:
City	:	ELMWOOD PARK
State	:	IL
Zip	:	60707-2028
Country	:	US
Telephone Number	:	440-279-0599
Fax Number	:	440-279-0593

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. S DAVID DEMOREST
Credential	:	M.D.
Telephone Number	:	440-279-0599

Provider Enumeration Date	:	03/14/2009
Last Update Date	:	03/14/2009

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