MEDICARE: KEY I. NAM, MD, SC.

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	225500000X	Respiratory/Developmental/Rehabilitative Specialist/Technologist	036043256	IL

General Provider Information

NPI Number	:	1457526063
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEY I. NAM, MD, SC.

Provider Business Mailing Address
First Line	:	3434 W PETERSON AVE
Second Line	:	SUITE 202
City	:	CHICAGO
State	:	IL
Zip	:	60659-3319
Country	:	US
Telephone Number	:	773-267-0781
Fax Number	:

Provider Business Practice Location Address
First Line	:	3434 W PETERSON AVE
Second Line	:	SUITE 202
City	:	CHICAGO
State	:	IL
Zip	:	60659-3319
Country	:	US
Telephone Number	:	773-267-0781
Fax Number	:

Authorized Official
Title or Position	:	MD
Name	:	KEY I NAM
Credential	:
Telephone Number	:	773-267-0781

Provider Enumeration Date	:	04/24/2008
Last Update Date	:	06/03/2008

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