MEDICARE: TIMOTHY L. STRAKA D.D.S., L.L.C.

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	019018122	IL

General Provider Information

NPI Number	:	1205132925
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TIMOTHY L. STRAKA D.D.S., L.L.C.

Provider Business Mailing Address
First Line	:	2409 W WARREN BLVD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-2115
Country	:	US
Telephone Number	:	847-360-8450
Fax Number	:

Provider Business Practice Location Address
First Line	:	2409 W WARREN BLVD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-2115
Country	:	US
Telephone Number	:	847-360-8450
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	MR. TIMOTHY LARS STRAKA
Credential	:	D.D.S.
Telephone Number	:	847-360-8450

Provider Enumeration Date	:	01/27/2011
Last Update Date	:	01/27/2011

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