MEDICARE: KELSI ANN KARCH

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	171100000X	Acupuncturist	198.001391	IL

General Provider Information

NPI Number	:	1962916882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSI ANN KARCH

Provider Business Mailing Address
First Line	:	1400 W EDGEWATER AVE UNIT 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60660-4209
Country	:	US
Telephone Number	:	773-403-7912
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 W EDGEWATER AVE UNIT 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60660-4209
Country	:	US
Telephone Number	:	773-403-7912
Fax Number	:

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

Provider Enumeration Date	:	11/30/2017
Last Update Date	:	11/30/2017

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