MEDICARE: LYNNE R. ERAMO 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	207N00000X	Dermatology Physician	036-063855	IL

General Provider Information

NPI Number	:	1578721353
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNNE R. ERAMO M.D.

Provider Business Mailing Address
First Line	:	414 CHURCH ST
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60201-4514
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	414 CHURCH ST
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60201-4514
Country	:	US
Telephone Number	:	847-491-0539
Fax Number	:	847-491-0762

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

Provider Enumeration Date	:	05/28/2008
Last Update Date	:	05/28/2008

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