MEDICARE: JOHN THE BAPTIST HOUSTON 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	208800000X	Urology Physician	036-100082	IL
2	2088P0231X	Pediatric Urology Physician	036100082	IL

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	01634125	OTHER	IL	BCBS PROVIDER ID
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306831938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN THE BAPTIST HOUSTON MD

Provider Business Mailing Address
First Line	:	777 OAKMONT LN
Second Line	:	SUITE 1600
City	:	WESTMONT
State	:	IL
Zip	:	60559-5511
Country	:	US
Telephone Number	:	630-789-2550
Fax Number	:

Provider Business Practice Location Address
First Line	:	2400 N ASHLAND AVE
Second Line	:	SUITE 200
City	:	CHICAGO
State	:	IL
Zip	:	60614-2021
Country	:	US
Telephone Number	:	312-632-0032
Fax Number	:	773-409-5089

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

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	04/26/2021

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