MEDICARE: DR. RENEE S HARTZ 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	208D00000X	General Practice Physician	036051428	IL

General Provider Information

NPI Number	:	1134166648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RENEE S HARTZ MD

Provider Business Mailing Address
First Line	:	1032 BALDWIN LN
Second Line	:
City	:	OAK PARK
State	:	IL
Zip	:	60302-4445
Country	:	US
Telephone Number	:
Fax Number	:	708-386-5547

Provider Business Practice Location Address
First Line	:	6304 N NAGLE AVE STE 3
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60646
Country	:	US
Telephone Number	:	773-628-7654
Fax Number	:

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

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	07/02/2018

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