MEDICARE: CHICAGOLAND HOME BIRTH

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1417180431
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHICAGOLAND HOME BIRTH

Provider Business Mailing Address
First Line	:	6648 N FAIRFIELD AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60645-4406
Country	:	US
Telephone Number	:	773-895-3311
Fax Number	:	866-272-8433

Provider Business Practice Location Address
First Line	:	6648 N FAIRFIELD AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60645-4406
Country	:	US
Telephone Number	:	773-895-3311
Fax Number	:	866-272-8433

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MAYER EISENSTEIN
Credential	:	M.D.
Telephone Number	:	773-895-3311

Provider Enumeration Date	:	08/25/2009
Last Update Date	:	08/25/2009

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Directions to “CHICAGOLAND HOME BIRTH ” Practice Location

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