MEDICARE: MRS. LINA POSKUS DDS

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	1223G0001X	General Practice Dentistry	019024853	IL

General Provider Information

NPI Number	:	1891866695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LINA POSKUS DDS

Provider Business Mailing Address
First Line	:	15 W 234 79 STR
Second Line	:
City	:	BURR RIDGE
State	:	IL
Zip	:	60527
Country	:	US
Telephone Number	:	630-323-0505
Fax Number	:	630-323-0505

Provider Business Practice Location Address
First Line	:	4635 W 63 STR
Second Line	:	D
City	:	CHICAGO
State	:	IL
Zip	:	60629
Country	:	US
Telephone Number	:	773-735-7730
Fax Number	:	773-735-7707

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

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	07/08/2007

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