MEDICARE: LAWRENCE T. KACMAR MDSC

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	332B00000X	Durable Medical Equipment & Medical Supplies	036091557	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	202522	OTHER	IL	MEDICARE NUMBER

General Provider Information

NPI Number	:	1255567558
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAWRENCE T. KACMAR MDSC

Provider Business Mailing Address
First Line	:	3965 75TH ST
Second Line	:	SUITE 103
City	:	AURORA
State	:	IL
Zip	:	60504-7925
Country	:	US
Telephone Number	:	630-375-1625
Fax Number	:	630-375-1925

Provider Business Practice Location Address
First Line	:	3965 75TH ST
Second Line	:	SUITE 103
City	:	AURORA
State	:	IL
Zip	:	60504-7925
Country	:	US
Telephone Number	:	630-375-1625
Fax Number	:	630-375-1925

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. MARGARET M COOLEY
Credential	:
Telephone Number	:	630-375-1625

Provider Enumeration Date	:	06/02/2009
Last Update Date	:	06/02/2009

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