MEDICARE: SARA STRACK HALBACH M.S.

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	170300000X	Genetic Counselor (M.S.)	246.000040	IL

General Provider Information

NPI Number	:	1013906668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA STRACK HALBACH M.S.

Provider Business Mailing Address
First Line	:	5841 S MARYLAND AVE # MC0077
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60637-1447
Country	:	US
Telephone Number	:	773-702-2079
Fax Number	:

Provider Business Practice Location Address
First Line	:	5841 S MARYLAND AVE # MC0077
Second Line	:	UNIVERSITY OF CHICAGO, DEPT OF HUMAN GENETICS
City	:	CHICAGO
State	:	IL
Zip	:	60637-1447
Country	:	US
Telephone Number	:	773-702-2079
Fax Number	:

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

Provider Enumeration Date	:	10/17/2005
Last Update Date	:	05/27/2009

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