MEDICARE: ALLEN M PUTTERMAN 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		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1615355	OTHER	IL	BCBS PROVIDER NUMBER

General Provider Information

NPI Number	:	1578563904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLEN M PUTTERMAN M.D.

Provider Business Mailing Address
First Line	:	111 N WABASH AVE
Second Line	:	STE 1722
City	:	CHICAGO
State	:	IL
Zip	:	60602-1903
Country	:	US
Telephone Number	:	312-372-2256
Fax Number	:	312-372-1762

Provider Business Practice Location Address
First Line	:	111 N WABASH AVE
Second Line	:	STE 1722
City	:	CHICAGO
State	:	IL
Zip	:	60602-1903
Country	:	US
Telephone Number	:	312-372-2256
Fax Number	:	312-372-1762

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

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	12/26/2007

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Directions to “ ALLEN M PUTTERMAN M.D.” Practice Location

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