MEDICARE: SUSAN JANE TAUB MD SC

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	207W00000X	Ophthalmology Physician		IL

General Provider Information

NPI Number	:	1376726745
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUSAN JANE TAUB MD SC

Provider Business Mailing Address
First Line	:	2650 N LAKEVIEW AVE
Second Line	:	1506
City	:	CHICAGO
State	:	IL
Zip	:	60614-1840
Country	:	US
Telephone Number	:	312-735-8208
Fax Number	:	312-268-5297

Provider Business Practice Location Address
First Line	:	1444 S MICHIGAN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60605-4827
Country	:	US
Telephone Number	:	312-810-2020
Fax Number	:	312-268-5297

Authorized Official
Title or Position	:	PRINCIPAL
Name	:	DR. SUSAN JANE TAUB
Credential	:	MD
Telephone Number	:	312-735-8208

Provider Enumeration Date	:	12/09/2007
Last Update Date	:	12/09/2007

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