MEDICARE: JOSEPHINE H MO 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	207XS0106X	Orthopaedic Hand Surgery Physician	036106515	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	:	1780670216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPHINE H MO M.D.

Provider Business Mailing Address
First Line	:	1550 N NORTHWEST HWY
Second Line	:	SUITE 220
City	:	PARK RIDGE
State	:	IL
Zip	:	60068-1411
Country	:	US
Telephone Number	:	847-298-7024
Fax Number	:	847-298-7155

Provider Business Practice Location Address
First Line	:	1009 IL ROUTE 22
Second Line	:	SUITE 2
City	:	FOX RIVER GROVE
State	:	IL
Zip	:	60021-1998
Country	:	US
Telephone Number	:	847-842-9366
Fax Number	:	847-842-9467

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

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	12/30/2012

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Directions to “ JOSEPHINE H MO M.D.” Practice Location

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