MEDICARE: MY CHOICE MEDICAL

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	332B00000X	Durable Medical Equipment & Medical Supplies	2021404	IL

General Provider Information

NPI Number	:	1881905586
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MY CHOICE MEDICAL

Provider Business Mailing Address
First Line	:	2435 N RUTHERFORD AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60707-2216
Country	:	US
Telephone Number	:	773-882-2134
Fax Number	:	773-385-5398

Provider Business Practice Location Address
First Line	:	2435 N RUTHERFORD AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60707-2216
Country	:	US
Telephone Number	:	773-882-2134
Fax Number	:	773-385-5398

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOSE LUIS ALZATI
Credential	:
Telephone Number	:	773-882-2134

Provider Enumeration Date	:	06/28/2010
Last Update Date	:	03/10/2011

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