MEDICARE: JOYCE WOOD PA-C

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	363A00000X	Physician Assistant	085001464	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	205977	OTHER	IL	MEDICARE PIN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	385000297	OTHER	IL	IL CONTROLLED SUBSTANCE#

General Provider Information

NPI Number	:	1659590552
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOYCE WOOD PA-C

Provider Business Mailing Address
First Line	:	350 SURRYSE RD
Second Line	:	SUITE 100
City	:	LAKE ZURICH
State	:	IL
Zip	:	60047-3217
Country	:	US
Telephone Number	:	847-438-2144
Fax Number	:	847-719-0335

Provider Business Practice Location Address
First Line	:	350 SURRYSE RD
Second Line	:	SUITE 100
City	:	LAKE ZURICH
State	:	IL
Zip	:	60047-3217
Country	:	US
Telephone Number	:	847-438-2144
Fax Number	:	847-719-0335

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

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	08/28/2008

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Directions to “ JOYCE WOOD PA-C” Practice Location

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