MEDICARE: DR. RICHARD LADD PHELPS 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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	036052170	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770537482
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD LADD PHELPS MD

Provider Business Mailing Address
First Line	:	201 E HURON ST 11 205
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-2968
Country	:	US
Telephone Number	:	312-926-3670
Fax Number	:	312-926-3672

Provider Business Practice Location Address
First Line	:	201E HURON ST 11-205
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-2968
Country	:	US
Telephone Number	:	312-926-3670
Fax Number	:	312-926-3672

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

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	08/19/2015

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