MEDICARE: CHICAGO RHEUMATOLOGY AND MEDICAL CLINIC, S.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	261Q00000X	Clinic/Center	036129110	IL

General Provider Information

NPI Number	:	1285986380
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHICAGO RHEUMATOLOGY AND MEDICAL CLINIC, S.C.

Provider Business Mailing Address
First Line	:	5325 W BELMONT AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-4104
Country	:	US
Telephone Number	:	773-283-5700
Fax Number	:	773-283-6450

Provider Business Practice Location Address
First Line	:	5325 W BELMONT AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-4104
Country	:	US
Telephone Number	:	773-283-5700
Fax Number	:	773-283-6450

Authorized Official
Title or Position	:	M.D.
Name	:	DOROTHY BLONIARZ
Credential	:
Telephone Number	:	312-479-8760

Provider Enumeration Date	:	10/12/2012
Last Update Date	:	04/04/2013

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