MEDICARE: WINNING TEAM TRUCKING, INC.

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	347C00000X	Private Vehicle	B652-5207-7812	IL

General Provider Information

NPI Number	:	1689914343
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WINNING TEAM TRUCKING, INC.

Provider Business Mailing Address
First Line	:	4850 S LAKE PARK AVE
Second Line	:	SUITE 210
City	:	CHICAGO
State	:	IL
Zip	:	60615-2130
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4850 S LAKE PARK AVE
Second Line	:	SUITE 210
City	:	CHICAGO
State	:	IL
Zip	:	60615-2130
Country	:	US
Telephone Number	:	312-804-2141
Fax Number	:

Authorized Official
Title or Position	:	SOLE PROPRIETOR
Name	:	LAKEISHA BARNES
Credential	:
Telephone Number	:	312-804-2141

Provider Enumeration Date	:	02/18/2013
Last Update Date	:	02/18/2013

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Directions to “WINNING TEAM TRUCKING, INC. ” Practice Location

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