MEDICARE: TRANSFORMATION MEDICAL GROUP, P.C.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	103T00000X	Psychologist
3	103TB0200X	Cognitive & Behavioral Psychologist
4	106H00000X	Marriage & Family Therapist
5	163WP0808X	Psychiatric/Mental Health Registered Nurse
6	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
7	364SP0808X	Psychiatric/Mental Health Clinical Nurse Specialist
8	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1598586216
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRANSFORMATION MEDICAL GROUP, P.C.

Provider Business Mailing Address
First Line	:	171 N ABERDEEN ST STE 400
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60607-1670
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	171 N ABERDEEN ST STE 400
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60607-1670
Country	:	US
Telephone Number	:	646-509-8576
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. WARREN MCCAULEY
Credential	:	MD
Telephone Number	:	309-706-4315

Provider Enumeration Date	:	10/24/2024
Last Update Date	:	10/24/2024

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