MEDICARE: MS. BINDU TITUS

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	363LF0000X	Family Nurse Practitioner	209015140	IL

General Provider Information

NPI Number	:	1033653340
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BINDU TITUS

Provider Business Mailing Address
First Line	:	9581 DEE RD APT 1J
Second Line	:
City	:	DES PLAINES
State	:	IL
Zip	:	60016-3861
Country	:	US
Telephone Number	:	773-574-5529
Fax Number	:

Provider Business Practice Location Address
First Line	:	350 W KENSINGTON RD
Second Line	:	STE 120
City	:	MOUNT PROSPECT
State	:	IL
Zip	:	60056-1141
Country	:	US
Telephone Number	:	847-222-9595
Fax Number	:

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

Provider Enumeration Date	:	12/06/2016
Last Update Date	:	12/06/2016

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