MEDICARE: FLOS, LLC

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

General Provider Information

NPI Number	:	1245675255
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLOS, LLC

Provider Business Mailing Address
First Line	:	3425 W PETERSON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-3433
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3425 W PETERSON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-3433
Country	:	US
Telephone Number	:	312-725-6265
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	SALMAN PATEL
Credential	:
Telephone Number	:	312-725-6265

Provider Enumeration Date	:	05/03/2013
Last Update Date	:	05/03/2013

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