MEDICARE: MR. MARK REESE L.AC

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	171100000X	Acupuncturist		IL

General Provider Information

NPI Number	:	1093984015
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARK REESE L.AC

Provider Business Mailing Address
First Line	:	5054 N SHERIDAN RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-3118
Country	:	US
Telephone Number	:	773-506-8971
Fax Number	:

Provider Business Practice Location Address
First Line	:	5054 N SHERIDAN RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-3118
Country	:	US
Telephone Number	:	773-506-8971
Fax Number	:

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

Provider Enumeration Date	:	02/23/2008
Last Update Date	:	02/23/2008

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Directions to “ MR. MARK REESE L.AC” Practice Location

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