MEDICARE: TARGET CORPORATION

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	261QH0100X	Health Service Clinic/Center	209011031	IL

General Provider Information

NPI Number	:	1962833368
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TARGET CORPORATION

Provider Business Mailing Address
First Line	:	2112 W PETERSON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-4277
Country	:	US
Telephone Number	:	773-761-3001
Fax Number	:

Provider Business Practice Location Address
First Line	:	2112 W PETERSON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-4277
Country	:	US
Telephone Number	:	773-761-3001
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATIVE OFFICIAL
Name	:	PAUL TEUFER
Credential	:
Telephone Number	:	612-761-5638

Provider Enumeration Date	:	12/10/2013
Last Update Date	:	12/10/2013

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