MEDICARE: DR. MICHELLE MARKOWITZ OD

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	225X00000X	Occupational Therapist	056007554	IL
2	152W00000X	Optometrist	046010137	IL

General Provider Information

NPI Number	:	1972771301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHELLE MARKOWITZ OD

Provider Business Mailing Address
First Line	:	2736 N CLARK ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-1503
Country	:	US
Telephone Number	:	773-248-0863
Fax Number	:

Provider Business Practice Location Address
First Line	:	2736 N CLARK ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-1503
Country	:	US
Telephone Number	:	773-248-0863
Fax Number	:

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

Provider Enumeration Date	:	02/19/2008
Last Update Date	:	10/20/2008

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Directions to “ DR. MICHELLE MARKOWITZ OD” Practice Location

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