MEDICARE: BEVEL UP MEDICAL SERVICES

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	247ZC0005X	Clinical Laboratory Director (Non-physician)

General Provider Information

NPI Number	:	1891528816
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEVEL UP MEDICAL SERVICES

Provider Business Mailing Address
First Line	:	1130 S CANAL ST # 1347
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60607-4907
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1105 W 104TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60643-3052
Country	:	US
Telephone Number	:	312-401-1508
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KENDRA S WINSTON
Credential	:
Telephone Number	:	312-401-1508

Provider Enumeration Date	:	08/23/2024
Last Update Date	:	08/23/2024

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Directions to “BEVEL UP MEDICAL SERVICES ” Practice Location

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