MEDICARE: MS. EBONIE CALDWELL

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	251E00000X	Home Health Agency
2	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1497056659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. EBONIE CALDWELL

Provider Business Mailing Address
First Line	:	211 E OHIO ST
Second Line	:	SUITE 1621
City	:	CHICAGO
State	:	IL
Zip	:	60611-3262
Country	:	US
Telephone Number	:	312-523-9084
Fax Number	:

Provider Business Practice Location Address
First Line	:	211 E OHIO ST
Second Line	:	SUITE 1621
City	:	CHICAGO
State	:	IL
Zip	:	60611-3262
Country	:	US
Telephone Number	:	312-523-9084
Fax Number	:

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

Provider Enumeration Date	:	11/04/2010
Last Update Date	:	11/04/2010

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