MEDICARE: TRAVEL MEDICINE SOURCE LTD

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	207RI0200X	Infectious Disease Physician

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

General Provider Information

NPI Number	:	1962571737
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRAVEL MEDICINE SOURCE LTD

Provider Business Mailing Address
First Line	:	9201 WAUKEGAN RD
Second Line	:
City	:	MORTON GROVE
State	:	IL
Zip	:	60053-2102
Country	:	US
Telephone Number	:	847-663-1566
Fax Number	:	847-663-1568

Provider Business Practice Location Address
First Line	:	9201 WAUKEGAN RD
Second Line	:
City	:	MORTON GROVE
State	:	IL
Zip	:	60053-2102
Country	:	US
Telephone Number	:	847-663-1566
Fax Number	:	847-663-1568

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. MARY CATHERINE MACGREGOR
Credential	:	DO
Telephone Number	:	847-663-1566

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	03/31/2015

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Directions to “TRAVEL MEDICINE SOURCE LTD ” Practice Location

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