MEDICARE: MS. STEPHANIE SUMMERS

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	172A00000X	Driver	S56278166683	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972779361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. STEPHANIE SUMMERS

Provider Business Mailing Address
First Line	:	1594 KENILWORTH DR
Second Line	:
City	:	CALUMET CITY
State	:	IL
Zip	:	60409-6306
Country	:	US
Telephone Number	:	773-425-8243
Fax Number	:	773-667-9622

Provider Business Practice Location Address
First Line	:	1594 KENILWORTH DR
Second Line	:
City	:	CALUMET CITY
State	:	IL
Zip	:	60409-6306
Country	:	US
Telephone Number	:	773-425-8243
Fax Number	:	773-667-9622

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

Provider Enumeration Date	:	05/05/2008
Last Update Date	:	05/05/2008

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