MEDICARE: CALUMET PHYSICIANS ASS LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	207P00000X	Emergency Medicine Physician	IL
2	207R00000X	Internal Medicine Physician	IL
3	207Q00000X	Family Medicine Physician	IL

General Provider Information

NPI Number	:	1538269964
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CALUMET PHYSICIANS ASS LTD

Provider Business Mailing Address
First Line	:	67 W 111TH ST STE 301
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60628-4247
Country	:	US
Telephone Number	:	773-995-3405
Fax Number	:	773-995-3408

Provider Business Practice Location Address
First Line	:	67 W 111TH ST STE 301
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60628-4247
Country	:	US
Telephone Number	:	773-995-3405
Fax Number	:	773-995-3408

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JAI DEV ARYA
Credential	:	M.D.
Telephone Number	:	773-995-3405

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	09/13/2007

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