MEDICARE: TO WALK IN MY SHOES

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	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1881316230
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TO WALK IN MY SHOES

Provider Business Mailing Address
First Line	:	3 N CICERO AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60644-3602
Country	:	US
Telephone Number	:	773-413-7283
Fax Number	:	773-413-7334

Provider Business Practice Location Address
First Line	:	3 N CICERO AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60644-3602
Country	:	US
Telephone Number	:	773-413-7283
Fax Number	:	773-413-7334

Authorized Official
Title or Position	:	OWNER
Name	:	SHRONE CONAWAY
Credential	:
Telephone Number	:	773-413-7283

Provider Enumeration Date	:	09/13/2022
Last Update Date	:	09/13/2022

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Directions to “TO WALK IN MY SHOES ” Practice Location

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