MEDICARE: MRS. RAFAELA MUNOZ ULRICH MD

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		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0004604376	OTHER	TX	AETNA
2	0021602210	OTHER	IL	BC BS

General Provider Information

NPI Number	:	1578650230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RAFAELA MUNOZ ULRICH MD

Provider Business Mailing Address
First Line	:	2844 N MILWAUKEE AVENUE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-7401
Country	:	US
Telephone Number	:	773-252-1344
Fax Number	:	773-252-5512

Provider Business Practice Location Address
First Line	:	2844 N MILWAUKEE AVENUE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-7401
Country	:	US
Telephone Number	:	773-252-1344
Fax Number	:	773-252-5512

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

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	07/08/2007

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