MEDICARE: DR. HENRY GURALNICK M.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	208600000X	Surgery Physician	036037149	IL

General Provider Information

NPI Number	:	1942504006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HENRY GURALNICK M.D.

Provider Business Mailing Address
First Line	:	1105 ASHLAND AVE
Second Line	:
City	:	RIVER FOREST
State	:	IL
Zip	:	60305-1437
Country	:	US
Telephone Number	:	708-366-8773
Fax Number	:	708-771-1875

Provider Business Practice Location Address
First Line	:	1105 ASHLAND AVE
Second Line	:
City	:	RIVER FOREST
State	:	IL
Zip	:	60305-1437
Country	:	US
Telephone Number	:	708-366-8773
Fax Number	:	708-771-1875

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

Provider Enumeration Date	:	01/04/2011
Last Update Date	:	01/04/2011

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