MEDICARE: DONALD MCGOVERN CPO

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	222Z00000X	Orthotist	213.000039	IL
2	224P00000X	Prosthetist	211.000026	IL

General Provider Information

NPI Number	:	1467783217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONALD MCGOVERN CPO

Provider Business Mailing Address
First Line	:	4039 ELLINGTON AVE
Second Line	:
City	:	WESTERN SPRINGS
State	:	IL
Zip	:	60558-1206
Country	:	US
Telephone Number	:	708-246-1835
Fax Number	:

Provider Business Practice Location Address
First Line	:	345 E SUPERIOR ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-2654
Country	:	US
Telephone Number	:	312-238-1000
Fax Number	:

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

Provider Enumeration Date	:	01/19/2010
Last Update Date	:	01/19/2010

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