MEDICARE: MICHAEL JUTOVSKY MD LLC

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	207Q00000X	Family Medicine Physician	036080157	IL
2	208M00000X	Hospitalist Physician	036080157	IL

General Provider Information

NPI Number	:	1750463295
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL JUTOVSKY MD LLC

Provider Business Mailing Address
First Line	:	6326 N LINCOLN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-1204
Country	:	US
Telephone Number	:	773-463-4100
Fax Number	:	773-463-4102

Provider Business Practice Location Address
First Line	:	6326 N LINCOLN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-1204
Country	:	US
Telephone Number	:	773-463-4100
Fax Number	:	773-463-4102

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	MICHAEL H JUTOVSKY
Credential	:	M.D.
Telephone Number	:	773-463-4100

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	01/02/2013

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