MEDICARE: DR. JOHN T FLANAGAN DPM

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	213ES0103X	Foot & Ankle Surgery Podiatrist	016004189	IL

General Provider Information

NPI Number	:	1174511174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN T FLANAGAN DPM

Provider Business Mailing Address
First Line	:	6304 N NAGLE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60646-3614
Country	:	US
Telephone Number	:	773-853-0081
Fax Number	:	773-853-2970

Provider Business Practice Location Address
First Line	:	6304 N NAGLE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60646-3614
Country	:	US
Telephone Number	:	773-853-0081
Fax Number	:	773-853-2970

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

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	06/04/2013

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