MEDICARE: LLOYD SIGMAN D.D.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	122300000X	Dentist	019.021136	IL
2	1223G0001X	General Practice Dentistry	019.021136	IL

General Provider Information

NPI Number	:	1063837987
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LLOYD SIGMAN D.D.S.

Provider Business Mailing Address
First Line	:	275 COACHMAKER DR
Second Line	:
City	:	NORTHBROOK
State	:	IL
Zip	:	60062-1507
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1770 1ST ST STE 410
Second Line	:
City	:	HIGHLAND PARK
State	:	IL
Zip	:	60035-3237
Country	:	US
Telephone Number	:	847-432-5520
Fax Number	:

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

Provider Enumeration Date	:	02/28/2014
Last Update Date	:	02/28/2014

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