MEDICARE: OPTIONS MEDICAL LLC

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	111N00000X	Chiropractor	038012545	IL
2	363L00000X	Nurse Practitioner	209011079	IL
3	208D00000X	General Practice Physician	036127953	IL

General Provider Information

NPI Number	:	1578977328
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTIONS MEDICAL LLC

Provider Business Mailing Address
First Line	:	1147 S WABASH AVE
Second Line	:	SUITE 250
City	:	CHICAGO
State	:	IL
Zip	:	60605-2346
Country	:	US
Telephone Number	:	312-360-1604
Fax Number	:

Provider Business Practice Location Address
First Line	:	1147 S WABASH AVE
Second Line	:	SUITE 250
City	:	CHICAGO
State	:	IL
Zip	:	60605-2346
Country	:	US
Telephone Number	:	312-360-1604
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MATTHEW WALKER
Credential	:
Telephone Number	:	312-360-1604

Provider Enumeration Date	:	06/19/2014
Last Update Date	:	09/15/2014

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Directions to “OPTIONS MEDICAL LLC ” Practice Location

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