MEDICARE: SHIREEN LUM DPM

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	213ES0103X	Foot & Ankle Surgery Podiatrist	016.005380	IL

General Provider Information

NPI Number	:	1528223500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHIREEN LUM DPM

Provider Business Mailing Address
First Line	:	2222 W DIVISION ST STE 105
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-3093
Country	:	US
Telephone Number	:	773-862-3600
Fax Number	:

Provider Business Practice Location Address
First Line	:	2222 W DIVISION ST STE 105
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-3093
Country	:	US
Telephone Number	:	773-862-3600
Fax Number	:

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

Provider Enumeration Date	:	07/18/2008
Last Update Date	:	07/18/2008

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Directions to “ SHIREEN LUM DPM” Practice Location

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