MEDICARE: DR. REBECCA MARION WURTZ 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	207RI0200X	Infectious Disease Physician		IL

General Provider Information

NPI Number	:	1902947955
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. REBECCA MARION WURTZ MD

Provider Business Mailing Address
First Line	:	2112 W LUNT AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60645-4816
Country	:	US
Telephone Number	:	773-743-4213
Fax Number	:	773-761-7546

Provider Business Practice Location Address
First Line	:	2112 W LUNT AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60645-4816
Country	:	US
Telephone Number	:	773-743-4213
Fax Number	:	773-761-7546

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

Provider Enumeration Date	:	02/11/2007
Last Update Date	:	07/08/2007

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