MEDICARE: VALERIA TARTACOVSCHI ELECTROLOGIST

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	246Z00000X	Other Specialist/Technologist	220000230	IL

General Provider Information

NPI Number	:	1992394670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VALERIA TARTACOVSCHI ELECTROLOGIST

Provider Business Mailing Address
First Line	:	1060 W HOLLYWOOD AVE APT 504
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60660-4575
Country	:	US
Telephone Number	:	252-722-5006
Fax Number	:

Provider Business Practice Location Address
First Line	:	2301 N CLARK ST STE 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-3487
Country	:	US
Telephone Number	:	252-722-5006
Fax Number	:

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

Provider Enumeration Date	:	01/15/2021
Last Update Date	:	01/15/2021

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