MEDICARE: DR. LAURA LOUISE SEMBA MD

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	208200000X	Plastic Surgery Physician		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01608167	OTHER	IL	BCBS INS
2	4526301	OTHER	IL	AETNA INS

General Provider Information

NPI Number	:	1689745127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAURA LOUISE SEMBA MD

Provider Business Mailing Address
First Line	:	14315 SOUTH 108TH AVENUE
Second Line	:	SUITE 114
City	:	ORLAND PARK
State	:	IL
Zip	:	60467-5701
Country	:	US
Telephone Number	:	708-873-1101
Fax Number	:	708-873-9909

Provider Business Practice Location Address
First Line	:	14315 SOUTH 108TH AVENUE
Second Line	:	SUITE 114
City	:	ORLAND PARK
State	:	IL
Zip	:	60467-5701
Country	:	US
Telephone Number	:	708-873-1101
Fax Number	:	708-873-9909

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

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	07/08/2007

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