MEDICARE: MRS. KATHERINE ANN EKSTROM NP

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	261QP0905X	State or Local Public Health Clinic/Center		IL

General Provider Information

NPI Number	:	1134335573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHERINE ANN EKSTROM NP

Provider Business Mailing Address
First Line	:	5016 N MONTICELLO AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-5522
Country	:	US
Telephone Number	:	312-744-5507
Fax Number	:	312-744-2573

Provider Business Practice Location Address
First Line	:	2861 N CLARK ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-5207
Country	:	US
Telephone Number	:	312-744-5507
Fax Number	:	312-744-2573

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

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	07/08/2007

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