MEDICARE: WESTERN SPRINGS FAMILY PRACTICE CENTER, LTD.

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	42005694	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CF5017	OTHER	IL	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	1617057	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1417992306
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTERN SPRINGS FAMILY PRACTICE CENTER, LTD.

Provider Business Mailing Address
First Line	:	5600 WOLF RD
Second Line	:	SUITE 140
City	:	WESTERN SPRINGS
State	:	IL
Zip	:	60558-2254
Country	:	US
Telephone Number	:	708-246-7222
Fax Number	:

Provider Business Practice Location Address
First Line	:	5600 WOLF RD
Second Line	:
City	:	WESTERN SPRINGS
State	:	IL
Zip	:	60558-2254
Country	:	US
Telephone Number	:	708-246-7222
Fax Number	:

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	KAREN RODGERS
Credential	:
Telephone Number	:	708-246-7222

Provider Enumeration Date	:	06/17/2006
Last Update Date	:	12/03/2007

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Directions to “WESTERN SPRINGS FAMILY PRACTICE CENTER, LTD. ” Practice Location

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