MEDICARE: MR. JAMES KEVIN BUSKIRK P.T.

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	174400000X	Specialist	070004145	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	650007085	OTHER	IL	MEDICARE RAILROAD - PALMETTO GBA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	200573902	OTHER	IL	TRANSIT REHABILITATION CENTERS OF CHICAGO
3	363396874	OTHER	IL	TAX ID PEAK THERAPEUTICS
4	01634372	OTHER	IL	BCBS GROUP NO.
5	1618443	OTHER	ID	BCBS IL GROUP ID
6	200573902	OTHER	IL	TAX ID BALANCE CTR OF IL
7	200573902	OTHER	IL	TRANSIT REHAB CENTERS OF CHICAGO

General Provider Information

NPI Number	:	1538101423
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES KEVIN BUSKIRK P.T.

Provider Business Mailing Address
First Line	:	3545 LAKE AVE
Second Line	:
City	:	WILMETTE
State	:	IL
Zip	:	60091-1058
Country	:	US
Telephone Number	:	847-251-2028
Fax Number	:	847-512-5064

Provider Business Practice Location Address
First Line	:	3545 LAKE AVE
Second Line	:
City	:	WILMETTE
State	:	IL
Zip	:	60091-1058
Country	:	US
Telephone Number	:	847-251-2028
Fax Number	:	847-512-5064

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

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	03/21/2012

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Directions to “ MR. JAMES KEVIN BUSKIRK P.T.” Practice Location

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