| Burgos Fuentes Service Corporation | |
|
229 W Grand Ave Ste Qw Bensenville IL 60106-3373 | |
| (630) 422-1917 | |
| (630) 422-7226 |
| Full Name | Burgos Fuentes Service Corporation |
|---|---|
| Speciality | Clinic/Center |
| Location | 229 W Grand Ave Ste Qw, Bensenville, Illinois |
| Authorized Official Name and Position | Miguel A Burgos (PRESIDENT) |
| Authorized Official Contact | 6304221917 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Burgos Fuentes Service Corporation 229 W Grand Ave Ste Qw Bensenville IL 60106-3373 Ph: (630) 422-1917 | Burgos Fuentes Service Corporation 229 W Grand Ave Ste Qw Bensenville IL 60106-3373 Ph: (630) 422-1917 |
| NPI Number | 1154491348 |
|---|---|
| Provider Enumeration Date | 11/08/2006 |
| Last Update Date | 12/01/2011 |
| Medicare PECOS PAC ID | 7719151802 |
|---|---|
| Medicare Enrollment ID | O20111130000330 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154491348 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 036103673 (Illinois) | Primary |
| Provider Name | Miguel A Burgos |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1013058379 PECOS PAC ID: 2163614496 Enrollment ID: I20101005001138 |
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