MEDICARE: U. S. MEDGROUP, P. A. DBA OCCSPECIALISTS P. C. (IL)

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	261QX0100X	Occupational Medicine Clinic/Center

General Provider Information

NPI Number	:	1801082300
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	U. S. MEDGROUP, P. A. DBA OCCSPECIALISTS P. C. (IL)

Provider Business Mailing Address
First Line	:	5080 SPECTRUM DR
Second Line	:	STE. 1200 WEST TOWER
City	:	ADDISON
State	:	TX
Zip	:	75001-4648
Country	:	US
Telephone Number	:	800-232-3550
Fax Number	:	800-401-6728

Provider Business Practice Location Address
First Line	:	2080 SPRINGER DR
Second Line	:
City	:	LOMBARD
State	:	IL
Zip	:	60148-6402
Country	:	US
Telephone Number	:	630-932-4540
Fax Number	:	630-932-4745

Authorized Official
Title or Position	:	EVP, CMO
Name	:	DR. TOM FOGARTY
Credential	:	MD
Telephone Number	:	800-232-3550

Provider Enumeration Date	:	09/18/2007
Last Update Date	:	09/18/2007

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