MEDICARE: PHOCUSED CONSULTING LLC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1679048334
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHOCUSED CONSULTING LLC

Provider Business Mailing Address
First Line	:	24644 S MULBERRY LN
Second Line	:
City	:	CRETE
State	:	IL
Zip	:	60417-3789
Country	:	US
Telephone Number	:	708-878-3016
Fax Number	:

Provider Business Practice Location Address
First Line	:	1324 E 79TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60619-3402
Country	:	US
Telephone Number	:	773-221-4224
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. PHILIP ALEXANDER
Credential	:
Telephone Number	:	708-878-3016

Provider Enumeration Date	:	10/09/2018
Last Update Date	:	11/30/2018

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Directions to “PHOCUSED CONSULTING LLC ” Practice Location

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