MEDICARE: DR. ROBERT MILTON BUMSTED M.D.

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	207Y00000X	Otolaryngology Physician	36-074514	IL

General Provider Information

NPI Number	:	1356518435
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT MILTON BUMSTED M.D.

Provider Business Mailing Address
First Line	:	1725 W HARRISON ST STE 340
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3852
Country	:	US
Telephone Number	:	312-664-6715
Fax Number	:	312-563-0165

Provider Business Practice Location Address
First Line	:	1725 W HARRISON ST STE 340
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3852
Country	:	US
Telephone Number	:	312-664-6715
Fax Number	:	312-563-0165

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

Provider Enumeration Date	:	05/08/2008
Last Update Date	:	05/08/2008

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