MEDICARE: DR. KATHERINE LAUTERBACH D.D.S.

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	1223G0001X	General Practice Dentistry	019017877	IL

General Provider Information

NPI Number	:	1528061520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHERINE LAUTERBACH D.D.S.

Provider Business Mailing Address
First Line	:	716 MICHIGAN AVE
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60202-2512
Country	:	US
Telephone Number	:	847-869-9950
Fax Number	:	847-869-4637

Provider Business Practice Location Address
First Line	:	1642 W BELMONT AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-3018
Country	:	US
Telephone Number	:	773-472-1200
Fax Number	:	773-472-1661

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	07/08/2007

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