MEDICARE: DR. ROGER PEYTON PLOTKIN 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	207Y00000X	Otolaryngology Physician		IL

General Provider Information

NPI Number	:	1770706798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROGER PEYTON PLOTKIN M.D.

Provider Business Mailing Address
First Line	:	1319 CHICAGO AVE
Second Line	:	SUITE 405
City	:	EVANSTON
State	:	IL
Zip	:	60201-5303
Country	:	US
Telephone Number	:	847-570-9359
Fax Number	:	847-570-9510

Provider Business Practice Location Address
First Line	:	1319 CHICAGO AVE
Second Line	:	SUITE 405
City	:	EVANSTON
State	:	IL
Zip	:	60201-5303
Country	:	US
Telephone Number	:	847-570-9359
Fax Number	:	847-570-9510

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

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	07/08/2007

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