MEDICARE: MS. LAEH ESTHER LITIN RD, ATC

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	173000000X	Legal Medicine	096-000761	IL
2	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1013980507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAEH ESTHER LITIN RD, ATC

Provider Business Mailing Address
First Line	:	6433 N WASHTENAW AVE
Second Line	:	APT 1
City	:	CHICAGO
State	:	IL
Zip	:	60645-5305
Country	:	US
Telephone Number	:	773-338-0914
Fax Number	:

Provider Business Practice Location Address
First Line	:	3633 N CALIFORNIA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-4602
Country	:	US
Telephone Number	:	773-539-3600
Fax Number	:	773-539-9158

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

Provider Enumeration Date	:	02/07/2006
Last Update Date	:	03/13/2015

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