MEDICARE: RENATA BLOCK PA

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	363A00000X	Physician Assistant	085-001907	IL
2	363A00000X	Physician Assistant	10004152A	IN

General Provider Information

NPI Number	:	1639129554
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENATA BLOCK PA

Provider Business Mailing Address
First Line	:	150 N MICHIGAN AVE
Second Line	:	SUITE 1200
City	:	CHICAGO
State	:	IL
Zip	:	60601-7553
Country	:	US
Telephone Number	:	312-263-4625
Fax Number	:	312-263-5029

Provider Business Practice Location Address
First Line	:	150 N MICHIGAN AVE
Second Line	:	SUITE 1200
City	:	CHICAGO
State	:	IL
Zip	:	60601-7553
Country	:	US
Telephone Number	:	312-263-4625
Fax Number	:	312-263-5029

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

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	03/29/2024

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Directions to “ RENATA BLOCK PA” Practice Location

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