MEDICARE: JULIA CORCORAN 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	2086S0122X	Plastic and Reconstructive Surgery Physician	036082569	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1627123	OTHER	IL	BCBS PROVIDER ID
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	363283051	OTHER	IL	OWCP PROVIDER ID

General Provider Information

NPI Number	:	1992790828
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIA CORCORAN MD

Provider Business Mailing Address
First Line	:	840 S WOOD ST
Second Line	:	MC 958
City	:	CHICAGO
State	:	IL
Zip	:	60612-4325
Country	:	US
Telephone Number	:	312-996-9313
Fax Number	:

Provider Business Practice Location Address
First Line	:	1801 W TAYLOR ST
Second Line	:	3F OCC MC 741
City	:	CHICAGO
State	:	IL
Zip	:	60612-4795
Country	:	US
Telephone Number	:	312-996-9313
Fax Number	:

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

Provider Enumeration Date	:	09/16/2005
Last Update Date	:	04/25/2017

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