MEDICARE: PAUL VOLTZ

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	1041C0700X	Clinical Social Worker		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01632322	OTHER	IL	BC/BS

General Provider Information

NPI Number	:	1922118058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL VOLTZ

Provider Business Mailing Address
First Line	:	14475 JOHN HUMPHREY DR
Second Line	:	LL-SUITE C
City	:	ORLAND PARK
State	:	IL
Zip	:	60462-6205
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	14475 JOHN HUMPHREY DR
Second Line	:	LL-SUITE C
City	:	ORLAND PARK
State	:	IL
Zip	:	60462-6205
Country	:	US
Telephone Number	:	708-557-7887
Fax Number	:

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/08/2007

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