MEDICARE: VIOS FERTILITY INSTITUTE CHICAGO

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	207VE0102X	Reproductive Endocrinology Physician

General Provider Information

NPI Number	:	1689182859
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIOS FERTILITY INSTITUTE CHICAGO

Provider Business Mailing Address
First Line	:	1455 N MILWAUKEE AVE FL 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-2015
Country	:	US
Telephone Number	:	773-435-9036
Fax Number	:	773-770-4626

Provider Business Practice Location Address
First Line	:	1455 N MILWAUKEE AVE FL 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-2015
Country	:	US
Telephone Number	:	773-435-9036
Fax Number	:	773-770-4626

Authorized Official
Title or Position	:	DIRECTOF OF INSURANCE CREDENTIALING
Name	:	KATRINA MARSHALL
Credential	:	RMC
Telephone Number	:	773-435-9036

Provider Enumeration Date	:	01/22/2018
Last Update Date	:	05/03/2023

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