MEDICARE: UNICE LEE WOODS

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	302R00000X	Health Maintenance Organization		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	141939646	OTHER	IL	TAX IDENIFICATION NUMBER

General Provider Information

NPI Number	:	1265737670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	UNICE LEE WOODS

Provider Business Mailing Address
First Line	:	80 E CERMAK RD
Second Line	:	A1
City	:	CHICAGO
State	:	IL
Zip	:	60616-2123
Country	:	US
Telephone Number	:	312-794-5193
Fax Number	:	312-794-5286

Provider Business Practice Location Address
First Line	:	80 E CERMAK RD
Second Line	:	A1
City	:	CHICAGO
State	:	IL
Zip	:	60616-2123
Country	:	US
Telephone Number	:	312-794-5193
Fax Number	:	312-794-5286

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

Provider Enumeration Date	:	01/14/2011
Last Update Date	:	01/14/2011

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Directions to “ UNICE LEE WOODS ” Practice Location

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