MEDICARE: KELLY FURMANEK DIPL. OM

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	171100000X	Acupuncturist	198000885	IL

General Provider Information

NPI Number	:	1316288137
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY FURMANEK DIPL. OM

Provider Business Mailing Address
First Line	:	125 S MADISON AVE
Second Line	:
City	:	LA GRANGE
State	:	IL
Zip	:	60525-2341
Country	:	US
Telephone Number	:	312-401-1185
Fax Number	:

Provider Business Practice Location Address
First Line	:	10059 S ROBERTS RD
Second Line	:
City	:	PALOS HILLS
State	:	IL
Zip	:	60465-1560
Country	:	US
Telephone Number	:	708-598-9144
Fax Number	:

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

Provider Enumeration Date	:	03/04/2013
Last Update Date	:	03/04/2013

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