| Evelyn G. Basco,m.d.,s.c. | |
|
3900 W Madison St Chicago IL 60624-2354 | |
| (773) 533-3440 | |
| Not Available |
| Full Name | Evelyn G. Basco,m.d.,s.c. |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 3900 W Madison St, Chicago, Illinois |
| Authorized Official Name and Position | Evelyn Ganaden Basco (PRESIDENT) |
| Authorized Official Contact | 7735333440 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Evelyn G. Basco,m.d.,s.c. 3900 W Madison St Chicago IL 60624-2354 Ph: (773) 533-3440 | Evelyn G. Basco,m.d.,s.c. 3900 W Madison St Chicago IL 60624-2354 Ph: (773) 533-3440 |
| NPI Number | 1235373853 |
|---|---|
| Provider Enumeration Date | 04/27/2009 |
| Last Update Date | 06/10/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235373853 | NPI | - | NPPES |
| 036055675 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 036055675 (Illinois) | Primary |
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