MEDICARE: ROYALTY TRAVEL

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	347C00000X	Private Vehicle	M32486080701	IL

General Provider Information

NPI Number	:	1700327277
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROYALTY TRAVEL

Provider Business Mailing Address
First Line	:	3647 W 80TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60652-2413
Country	:	US
Telephone Number	:	773-671-1635
Fax Number	:

Provider Business Practice Location Address
First Line	:	3647 W 80TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60652-2413
Country	:	US
Telephone Number	:	773-671-1635
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	VERALEKA MITCHELL
Credential	:
Telephone Number	:	773-671-1635

Provider Enumeration Date	:	03/16/2017
Last Update Date	:	03/16/2017

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Directions to “ROYALTY TRAVEL ” Practice Location

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