MEDICARE: VIOS FERTILITY INSTITUTE CHICAGO

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	207VE0102X	Reproductive Endocrinology Physician	336.019128	IL
2	207VE0102X	Reproductive Endocrinology Physician	336.050582	IL

General Provider Information

NPI Number	:	1982059275
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIOS FERTILITY INSTITUTE CHICAGO

Provider Business Mailing Address
First Line	:	2516 WAUKEGAN RD
Second Line	:	370
City	:	GLENVIEW
State	:	IL
Zip	:	60025-1774
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1455 N MILWAUKEE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-2015
Country	:	US
Telephone Number	:	866-258-8467
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	HANNAH JOHNSON
Credential	:
Telephone Number	:	312-433-9324

Provider Enumeration Date	:	04/25/2016
Last Update Date	:	04/25/2016

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Directions to “VIOS FERTILITY INSTITUTE CHICAGO ” Practice Location

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