MEDICARE: DR. BETSY PEPPER MD

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	174400000X	Specialist	36-055211	IL

General Provider Information

NPI Number	:	1437141223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BETSY PEPPER MD

Provider Business Mailing Address
First Line	:	467 W DEMING PL
Second Line	:	SUITE 500
City	:	CHICAGO
State	:	IL
Zip	:	60614-1881
Country	:	US
Telephone Number	:	773-388-6390
Fax Number	:

Provider Business Practice Location Address
First Line	:	467 W DEMING PL
Second Line	:	SUITE 500
City	:	CHICAGO
State	:	IL
Zip	:	60614-1881
Country	:	US
Telephone Number	:	773-388-6390
Fax Number	:

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

Provider Enumeration Date	:	08/17/2005
Last Update Date	:	03/06/2008

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