MEDICARE: ELIZABETH T. OSTEN AND ASSOCIATES

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	261QM1300X	Multi-Specialty Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	816721	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1992714695
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELIZABETH T. OSTEN AND ASSOCIATES

Provider Business Mailing Address
First Line	:	5225 OLD ORCHARD RD
Second Line	:	SUITE 18
City	:	SKOKIE
State	:	IL
Zip	:	60077-4405
Country	:	US
Telephone Number	:	847-663-1020
Fax Number	:	847-663-1022

Provider Business Practice Location Address
First Line	:	5225 OLD ORCHARD RD
Second Line	:	SUITE 18
City	:	SKOKIE
State	:	IL
Zip	:	60077-4405
Country	:	US
Telephone Number	:	847-663-1020
Fax Number	:	847-663-1022

Authorized Official
Title or Position	:	OWNER & CEO
Name	:	MS. ELIZABETH T. OSTEN
Credential	:	MS, OTR/L
Telephone Number	:	847-663-1020

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	08/27/2007

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