MEDICARE: PAULA RUTH MARKOWITZ PSYD

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	103TC0700X	Clinical Psychologist	071004473	IL

General Provider Information

NPI Number	:	1952562670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAULA RUTH MARKOWITZ PSYD

Provider Business Mailing Address
First Line	:	1741 WEST GEORGE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-4086
Country	:	US
Telephone Number	:	312-456-0012
Fax Number	:

Provider Business Practice Location Address
First Line	:	8 SOUTH MICHIGAN
Second Line	:	SUITE 1500
City	:	CHICAGO
State	:	IL
Zip	:	60603
Country	:	US
Telephone Number	:	312-456-0012
Fax Number	:

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

Provider Enumeration Date	:	06/25/2008
Last Update Date	:	06/25/2008

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