MEDICARE: DR. MARTHA MARIA KACHMARYK MD

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	207W00000X	Ophthalmology Physician	036092803	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0004932263	OTHER	IL	BCBS NUMBER

General Provider Information

NPI Number	:	1528110392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARTHA MARIA KACHMARYK MD

Provider Business Mailing Address
First Line	:	2004 N PULASKI RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60639-3767
Country	:	US
Telephone Number	:	773-772-8876
Fax Number	:	773-252-8091

Provider Business Practice Location Address
First Line	:	2004 N PULASKI RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60639-3767
Country	:	US
Telephone Number	:	773-772-8876
Fax Number	:	773-252-8091

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

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	10/02/2015

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