MEDICARE: SECOND CITY ORTHODONTICS, P.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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry

General Provider Information

NPI Number	:	1225711864
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SECOND CITY ORTHODONTICS, P.C.

Provider Business Mailing Address
First Line	:	1665 DUFFY LN
Second Line	:
City	:	BANNOCKBURN
State	:	IL
Zip	:	60015-1509
Country	:	US
Telephone Number	:	847-347-7874
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 N WABASH AVE STE 810
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60602-1912
Country	:	US
Telephone Number	:	312-551-0500
Fax Number	:	312-372-0165

Authorized Official
Title or Position	:	SECRETARY
Name	:	DR. FRANK L KARKAZIS
Credential	:	D.D.S.
Telephone Number	:	847-347-7874

Provider Enumeration Date	:	08/10/2023
Last Update Date	:	08/10/2023

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Directions to “SECOND CITY ORTHODONTICS, P.C. ” Practice Location

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