MEDICARE: MICHAEL R FIORUCCI MD

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	208600000X	Surgery Physician	47268	WI
2	208600000X	Surgery Physician	036108602	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598760480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL R FIORUCCI MD

Provider Business Mailing Address
First Line	:	2850 W 95TH ST
Second Line	:	SUITE 306
City	:	EVERGREEN PARK
State	:	IL
Zip	:	60805-2735
Country	:	US
Telephone Number	:	708-422-8500
Fax Number	:	708-229-6081

Provider Business Practice Location Address
First Line	:	2850 W 95TH ST
Second Line	:	SUITE 306
City	:	EVERGREEN PARK
State	:	IL
Zip	:	60805-2735
Country	:	US
Telephone Number	:	708-422-8500
Fax Number	:	708-229-6081

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	06/19/2014

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Directions to “ MICHAEL R FIORUCCI MD” Practice Location

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