MEDICARE: MRS. MARGARET AHUVAH SEVERANCE L.AC.

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	171100000X	Acupuncturist		IL

General Provider Information

NPI Number	:	1003038704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARGARET AHUVAH SEVERANCE L.AC.

Provider Business Mailing Address
First Line	:	655 ROCKLAND RD
Second Line	:	SUITE 105
City	:	LAKE BLUFF
State	:	IL
Zip	:	60044-1782
Country	:	US
Telephone Number	:	847-735-1888
Fax Number	:	847-234-1792

Provider Business Practice Location Address
First Line	:	655 ROCKLAND RD
Second Line	:	SUITE 105
City	:	LAKE BLUFF
State	:	IL
Zip	:	60044-1782
Country	:	US
Telephone Number	:	847-735-1888
Fax Number	:	847-234-1792

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

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	07/08/2007

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