MEDICARE: MS. MICHELLE NANCY MADRID LMT

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	225700000X	Massage Therapist	227004934	IL

General Provider Information

NPI Number	:	1831423813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MICHELLE NANCY MADRID LMT

Provider Business Mailing Address
First Line	:	1610 W NELSON ST
Second Line	:	APT. 2
City	:	CHICAGO
State	:	IL
Zip	:	60657-3027
Country	:	US
Telephone Number	:	773-307-3466
Fax Number	:

Provider Business Practice Location Address
First Line	:	1610 W NELSON ST
Second Line	:	APT. 2
City	:	CHICAGO
State	:	IL
Zip	:	60657-3027
Country	:	US
Telephone Number	:	773-307-3466
Fax Number	:

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

Provider Enumeration Date	:	09/24/2009
Last Update Date	:	09/24/2009

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