MEDICARE: OPTIMUM HEALTH CLINIC

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	225100000X	Physical Therapist	070016717	IL
2	111NS0005X	Sports Physician Chiropractor	038009253	IL

General Provider Information

NPI Number	:	1649495474
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTIMUM HEALTH CLINIC

Provider Business Mailing Address
First Line	:	7 N WOLF RD
Second Line	:
City	:	PROSPECT HEIGHTS
State	:	IL
Zip	:	60070-1749
Country	:	US
Telephone Number	:	847-297-2225
Fax Number	:	247-297-2096

Provider Business Practice Location Address
First Line	:	7 N WOLF RD
Second Line	:
City	:	PROSPECT HEIGHTS
State	:	IL
Zip	:	60070-1749
Country	:	US
Telephone Number	:	847-297-2225
Fax Number	:	247-297-2096

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. DOTTI LOSIK
Credential	:
Telephone Number	:	847-297-2225

Provider Enumeration Date	:	04/16/2007
Last Update Date	:	11/02/2010

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Directions to “OPTIMUM HEALTH CLINIC ” Practice Location

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