MEDICARE: ADRIENNE RAY M.D.

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	207V00000X	Obstetrics & Gynecology Physician	036085007	IL
2	207VG0400X	Gynecology Physician	036085007	IL
3	207VX0000X	Obstetrics Physician	036085007	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	31603891	OTHER	IL	BC/BS PROVIDER NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1659387538	OTHER	IL	INDIVIDUAL NPI
4	1821211129	OTHER	IL	NPI GROUP NUMBER

General Provider Information

NPI Number	:	1659387538
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADRIENNE RAY M.D.

Provider Business Mailing Address
First Line	:	625 N MICHIGAN AVE
Second Line	:	STE #210
City	:	CHICAGO
State	:	IL
Zip	:	60611-3110
Country	:	US
Telephone Number	:	312-670-2530
Fax Number	:	312-670-2630

Provider Business Practice Location Address
First Line	:	625 N MICHIGAN AVE
Second Line	:	STE #210
City	:	CHICAGO
State	:	IL
Zip	:	60611-3110
Country	:	US
Telephone Number	:	312-670-2530
Fax Number	:	312-670-2630

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

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	07/01/2011

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Directions to “ ADRIENNE RAY M.D.” Practice Location

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