MEDICARE: MS. AMELIA M CONTE-RUSSIAN 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	207R00000X	Internal Medicine Physician	036067744	IL
2	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	036067744	IL

General Provider Information

NPI Number	:	1851338792
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMELIA M CONTE-RUSSIAN M.D.

Provider Business Mailing Address
First Line	:	3319 N ELSTON AVE
Second Line	:	SUITE 100
City	:	CHICAGO
State	:	IL
Zip	:	60618
Country	:	US
Telephone Number	:	773-751-7200
Fax Number	:	773-583-4295

Provider Business Practice Location Address
First Line	:	3319 N ELSTON AVE
Second Line	:	SUITE 100
City	:	CHICAGO
State	:	IL
Zip	:	60618
Country	:	US
Telephone Number	:	773-751-7200
Fax Number	:	773-583-4295

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

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	10/22/2012

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