MEDICARE: MR. JOSEPH MARTIN CHECK LCSW

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	101YM0800X	Mental Health Counselor	149-000518	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01671607	OTHER	IL	BLUE CROSS ID #

General Provider Information

NPI Number	:	1598815094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSEPH MARTIN CHECK LCSW

Provider Business Mailing Address
First Line	:	5228 S KENWOOD AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60615-4006
Country	:	US
Telephone Number	:	773-216-9859
Fax Number	:	773-493-6940

Provider Business Practice Location Address
First Line	:	5228 S KENWOOD AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60615-4006
Country	:	US
Telephone Number	:	773-216-9859
Fax Number	:	773-493-6940

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

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	07/08/2007

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