MEDICARE: DR. ADRIANA MARIE SPELLMAN 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	036-078559	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760474589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ADRIANA MARIE SPELLMAN M.D.

Provider Business Mailing Address
First Line	:	801 S MILWAUKEE AVE
Second Line	:	STE 100
City	:	LIBERTYVILLE
State	:	IL
Zip	:	60048-3204
Country	:	US
Telephone Number	:	847-680-3400
Fax Number	:

Provider Business Practice Location Address
First Line	:	801 S MILWAUKEE AVE
Second Line	:	STE 100
City	:	LIBERTYVILLE
State	:	IL
Zip	:	60048-3204
Country	:	US
Telephone Number	:	847-680-3400
Fax Number	:

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

Provider Enumeration Date	:	08/17/2005
Last Update Date	:	12/28/2022

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