MEDICARE: DR. KATRINA LYNN BIRCH M.D.

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	207V00000X	Obstetrics & Gynecology Physician	036140572	IL

General Provider Information

NPI Number	:	1720354715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATRINA LYNN BIRCH M.D.

Provider Business Mailing Address
First Line	:	1411 S MICHIGAN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60605-2810
Country	:	US
Telephone Number	:	312-454-2700
Fax Number	:	312-454-2701

Provider Business Practice Location Address
First Line	:	1411 S MICHIGAN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60605-2810
Country	:	US
Telephone Number	:	312-454-2700
Fax Number	:	312-454-2701

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

Provider Enumeration Date	:	03/24/2012
Last Update Date	:	03/14/2022

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