MEDICARE: DR. FREDERICK A SCELZO 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	207W00000X	Ophthalmology Physician	036043476	IL

General Provider Information

NPI Number	:	1871578310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FREDERICK A SCELZO M.D.

Provider Business Mailing Address
First Line	:	2150 PFINGSTEN RD
Second Line	:	SUITE 2240
City	:	GLENVIEW
State	:	IL
Zip	:	60026-1361
Country	:	US
Telephone Number	:	847-724-5608
Fax Number	:

Provider Business Practice Location Address
First Line	:	2150 PFINGSTEN RD
Second Line	:	SUITE 2240
City	:	GLENVIEW
State	:	IL
Zip	:	60026-1361
Country	:	US
Telephone Number	:	847-724-5608
Fax Number	:

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

Provider Enumeration Date	:	12/07/2005
Last Update Date	:	02/05/2013

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