MEDICARE: CORINNE MARIA LENTS PA-C

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	085-002574	IL

General Provider Information

NPI Number	:	1871627828
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CORINNE MARIA LENTS PA-C

Provider Business Mailing Address
First Line	:	9921 SOUTHWEST HWY
Second Line	:
City	:	OAK LAWN
State	:	IL
Zip	:	60453-3767
Country	:	US
Telephone Number	:	708-499-5678
Fax Number	:

Provider Business Practice Location Address
First Line	:	327 W SCHILLER ST
Second Line	:	C
City	:	CHICAGO
State	:	IL
Zip	:	60610-1827
Country	:	US
Telephone Number	:	949-395-1601
Fax Number	:

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

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	12/18/2008

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