MEDICARE: MR. JOHN T PICKEN 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		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01621679	OTHER	IL	BCBS OF IL
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831174317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN T PICKEN M.D.

Provider Business Mailing Address
First Line	:	2850 S WABASH AVE
Second Line	:	SUITE 106
City	:	CHICAGO
State	:	IL
Zip	:	60616-2955
Country	:	US
Telephone Number	:	312-842-4400
Fax Number	:	312-842-4595

Provider Business Practice Location Address
First Line	:	2850 S WABASH AVE
Second Line	:	SUITE 106
City	:	CHICAGO
State	:	IL
Zip	:	60616-2955
Country	:	US
Telephone Number	:	312-842-4400
Fax Number	:	312-842-4595

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

Provider Enumeration Date	:	12/07/2005
Last Update Date	:	09/10/2007

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