MEDICARE: DR. SHIRLEY LEE TERMOLEN 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	207R00000X	Internal Medicine Physician	036096045	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	363762672	OTHER	IL	TAX ID FOR PRACTICE

General Provider Information

NPI Number	:	1952369563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHIRLEY LEE TERMOLEN M.D.

Provider Business Mailing Address
First Line	:	200 S MICHIGAN AVE
Second Line	:	SUITE 805
City	:	CHICAGO
State	:	IL
Zip	:	60604-2402
Country	:	US
Telephone Number	:	312-922-3815
Fax Number	:	312-922-7449

Provider Business Practice Location Address
First Line	:	200 S MICHIGAN AVE
Second Line	:	SUITE 805
City	:	CHICAGO
State	:	IL
Zip	:	60604-2402
Country	:	US
Telephone Number	:	312-922-3815
Fax Number	:	312-922-7449

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

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	03/04/2011

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Directions to “ DR. SHIRLEY LEE TERMOLEN M.D.” Practice Location

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