MEDICARE: MS. KERI KWARTA AU.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	231H00000X	Audiologist		IL

General Provider Information

NPI Number	:	1891861969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KERI KWARTA AU.D.

Provider Business Mailing Address
First Line	:	470 W MAHOGANY CT
Second Line	:	#405
City	:	PALATINE
State	:	IL
Zip	:	60067-4998
Country	:	US
Telephone Number	:	847-963-0877
Fax Number	:

Provider Business Practice Location Address
First Line	:	1750 W HARRISON ST
Second Line	:	203 SENN
City	:	CHICAGO
State	:	IL
Zip	:	60612-3825
Country	:	US
Telephone Number	:	312-942-5332
Fax Number	:	312-942-7068

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

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	07/08/2007

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