MEDICARE: DR. MARY ELIZABETH HAUPERS DDS

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	122300000X	Dentist	019028004	IL

General Provider Information

NPI Number	:	1710212360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY ELIZABETH HAUPERS DDS

Provider Business Mailing Address
First Line	:	1702 N BISSELL ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-5506
Country	:	US
Telephone Number	:	847-254-1169
Fax Number	:

Provider Business Practice Location Address
First Line	:	1725 W NORTH AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-2188
Country	:	US
Telephone Number	:	773-227-1048
Fax Number	:

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

Provider Enumeration Date	:	10/14/2009
Last Update Date	:	10/14/2009

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