MEDICARE: DR. CAROLINE J. CHOI MD

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	036110561	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01601913	OTHER	IL	BCBS OF IL

General Provider Information

NPI Number	:	1063462646
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAROLINE J. CHOI MD

Provider Business Mailing Address
First Line	:	PO BOX 5202
Second Line	:
City	:	VERNON HILLS
State	:	IL
Zip	:	60061-5202
Country	:	US
Telephone Number	:	847-253-7777
Fax Number	:	847-590-1006

Provider Business Practice Location Address
First Line	:	1614 WEST CENTRAL AVE
Second Line	:	SUITE 202
City	:	ARLINGTON HTS
State	:	IL
Zip	:	60005-1534
Country	:	US
Telephone Number	:	847-253-7777
Fax Number	:	847-590-1006

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

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	03/06/2012

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