MEDICARE: REBECCA CECILIA PRESTON M.D.

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	207Q00000X	Family Medicine Physician	080973	IL

General Provider Information

NPI Number	:	1003883968
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA CECILIA PRESTON M.D.

Provider Business Mailing Address
First Line	:	4479 CENTRAL AVE
Second Line	:
City	:	WESTERN SPRINGS
State	:	IL
Zip	:	60558-1714
Country	:	US
Telephone Number	:	708-784-9000
Fax Number	:	708-784-9088

Provider Business Practice Location Address
First Line	:	4479 CENTRAL AVE
Second Line	:
City	:	WESTERN SPRINGS
State	:	IL
Zip	:	60558-1714
Country	:	US
Telephone Number	:	708-784-9000
Fax Number	:	708-784-9088

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

Provider Enumeration Date	:	02/28/2006
Last Update Date	:	11/01/2007

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