MEDICARE: DR. JOHN CHARLES HAUWILLER DMD

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	122300000X	Dentist	019018254	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	13812	OTHER	IL	BCBS

General Provider Information

NPI Number	:	1427126028
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN CHARLES HAUWILLER DMD

Provider Business Mailing Address
First Line	:	6 BARCLAY CT
Second Line	:
City	:	MONTGOMERY
State	:	IL
Zip	:	60538-2712
Country	:	US
Telephone Number	:	630-801-7657
Fax Number	:

Provider Business Practice Location Address
First Line	:	6 BARCLAY CT
Second Line	:
City	:	MONTGOMERY
State	:	IL
Zip	:	60538-2712
Country	:	US
Telephone Number	:	630-801-7657
Fax Number	:

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

Provider Enumeration Date	:	12/01/2006
Last Update Date	:	10/09/2011

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