MEDICARE: DR. MARY E ARLANDSON D.O.

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	207V00000X	Obstetrics & Gynecology Physician	036118858	IL

General Provider Information

NPI Number	:	1922261841
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY E ARLANDSON D.O.

Provider Business Mailing Address
First Line	:	1900 W POLK ST
Second Line	:	RM 1208 CREDENTIALS OFFICE C/O JOYCE LAUDERDALE
City	:	CHICAGO
State	:	IL
Zip	:	60612-3723
Country	:	US
Telephone Number	:	312-864-0453
Fax Number	:	312-864-0460

Provider Business Practice Location Address
First Line	:	1900 W POLK ST
Second Line	:	RM 1208 CREDENTIALS OFFICE C/O JOYCE LAUDERDALE
City	:	CHICAGO
State	:	IL
Zip	:	60612-3723
Country	:	US
Telephone Number	:	312-864-0453
Fax Number	:	312-864-0460

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

Provider Enumeration Date	:	07/10/2008
Last Update Date	:	04/21/2021

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