MEDICARE: JUDITH A KING M.D.

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	036-065178	IL
2	207QG0300X	Geriatric Medicine (Family Medicine) Physician	036-065178	IL

General Provider Information

NPI Number	:	1437448602
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDITH A KING M.D.

Provider Business Mailing Address
First Line	:	2907 S WABASH AVE STE 100A
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-3271
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2907 S WABASH AVE STE 100A
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-3271
Country	:	US
Telephone Number	:	773-477-3699
Fax Number	:

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

Provider Enumeration Date	:	03/28/2011
Last Update Date	:	01/14/2024

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