MEDICARE: THOMAS ALEXANDER CHIBUCOS M.S.

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	235Z00000X	Speech-Language Pathologist		IL

General Provider Information

NPI Number	:	1700921566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS ALEXANDER CHIBUCOS M.S.

Provider Business Mailing Address
First Line	:	2700 N HAMPDEN CT
Second Line	:	#24D
City	:	CHICAGO
State	:	IL
Zip	:	60614-1869
Country	:	US
Telephone Number	:	773-818-3491
Fax Number	:	773-524-2686

Provider Business Practice Location Address
First Line	:	2700 N HAMPDEN CT
Second Line	:	#24D
City	:	CHICAGO
State	:	IL
Zip	:	60614-1869
Country	:	US
Telephone Number	:	773-818-3491
Fax Number	:	773-524-2686

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

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	07/08/2007

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Directions to “ THOMAS ALEXANDER CHIBUCOS M.S.” Practice Location

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