MEDICARE: FORYS BIRN AND ASSOC P C

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	174400000X	Specialist
2	207R00000X	Internal Medicine Physician		IL

General Provider Information

NPI Number	:	1740474584
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FORYS BIRN AND ASSOC P C

Provider Business Mailing Address
First Line	:	5605 W GUNNISON STR
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-3212
Country	:	US
Telephone Number	:	773-545-2525
Fax Number	:	773-205-5700

Provider Business Practice Location Address
First Line	:	5605 W GUNNISON STR
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-3212
Country	:	US
Telephone Number	:	773-545-2525
Fax Number	:	773-205-5700

Authorized Official
Title or Position	:	PRESIDENT, PHYSICIAN
Name	:	DR. VICTOR ALEKSANDER FORYS
Credential	:	M.D.
Telephone Number	:	773-545-2525

Provider Enumeration Date	:	09/05/2007
Last Update Date	:	06/30/2011

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Directions to “FORYS BIRN AND ASSOC P C ” Practice Location

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