MEDICARE: DR. SAMUEL HOWARD WURSTER 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	208200000X	Plastic Surgery Physician		IL

General Provider Information

NPI Number	:	1942399761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMUEL HOWARD WURSTER MD

Provider Business Mailing Address
First Line	:	980 N MICHIGAN AVE
Second Line	:	SUITE 1417
City	:	CHICAGO
State	:	IL
Zip	:	60611-4501
Country	:	US
Telephone Number	:	312-214-3656
Fax Number	:

Provider Business Practice Location Address
First Line	:	980 N MICHIGAN AVE
Second Line	:	SUITE 1417
City	:	CHICAGO
State	:	IL
Zip	:	60611-4501
Country	:	US
Telephone Number	:	312-214-3656
Fax Number	:

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

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	07/08/2007

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