MEDICARE: KRISTIN MARIE SOPALA

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

General Provider Information

NPI Number	:	1922282748
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN MARIE SOPALA

Provider Business Mailing Address
First Line	:	835 N WOOD ST
Second Line	:	104
City	:	CHICAGO
State	:	IL
Zip	:	60622-5022
Country	:	US
Telephone Number	:	312-829-4007
Fax Number	:	312-829-4055

Provider Business Practice Location Address
First Line	:	835 N WOOD ST
Second Line	:	104
City	:	CHICAGO
State	:	IL
Zip	:	60622-5022
Country	:	US
Telephone Number	:	630-677-2698
Fax Number	:	312-327-9984

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

Provider Enumeration Date	:	12/28/2007
Last Update Date	:	01/03/2008

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Directions to “ KRISTIN MARIE SOPALA ” Practice Location

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