MEDICARE: DR. GREGORY A SPITZ M.D., F.A.C.S

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	208600000X	Surgery Physician	036071367	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	K50962	OTHER		MEDICARE PTAN

General Provider Information

NPI Number	:	1396859781
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY A SPITZ M.D., F.A.C.S

Provider Business Mailing Address
First Line	:	1256 WATERFORD DR
Second Line	:	SUITE 130
City	:	AURORA
State	:	IL
Zip	:	60504-4510
Country	:	US
Telephone Number	:	630-820-2727
Fax Number	:	630-820-7427

Provider Business Practice Location Address
First Line	:	1256 WATERFORD DR
Second Line	:	SUITE 130
City	:	AURORA
State	:	IL
Zip	:	60504-4510
Country	:	US
Telephone Number	:	630-820-2727
Fax Number	:	630-820-7427

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

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	05/23/2008

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Directions to “ DR. GREGORY A SPITZ M.D., F.A.C.S” Practice Location

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