MEDICARE: CYNTHIA A FLOORE 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	207Q00000X	Family Medicine Physician	036-092051	IL
2	207Q00000X	Family Medicine Physician	4301082097	MI
3	207Q00000X	Family Medicine Physician	35825020	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	08055000111	OTHER	MI	BC/BS MI

General Provider Information

NPI Number	:	1235126632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA A FLOORE MD

Provider Business Mailing Address
First Line	:	25245 W SAINT OLAF AVE
Second Line	:
City	:	INGLESIDE
State	:	IL
Zip	:	60041-9523
Country	:	US
Telephone Number	:	847-546-9062
Fax Number	:	847-546-9062

Provider Business Practice Location Address
First Line	:	2555 N MARTIN LUTHER KING DR
Second Line	:	MILWAUKEE HEALTH SERVICES, INC.
City	:	MILWAUKEE
State	:	WI
Zip	:	53212-2709
Country	:	US
Telephone Number	:	414-372-8080
Fax Number	:	414-372-7420

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

Provider Enumeration Date	:	09/30/2005
Last Update Date	:	04/13/2017

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