MEDICARE: JAMES HARITOS

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	019022173	IL

General Provider Information

NPI Number	:	1598162836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES HARITOS

Provider Business Mailing Address
First Line	:	5643 N FAIRFIELD AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-4816
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5643 N FAIRFIELD AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-4816
Country	:	US
Telephone Number	:	773-271-5200
Fax Number	:

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

Provider Enumeration Date	:	12/02/2014
Last Update Date	:	12/02/2014

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Directions to “ JAMES HARITOS ” Practice Location

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