Individual
HEBERT TASCON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
INC
Contact information
Practice address
5828 N MAPLEWOOD AVE, CHICAGO, IL 60659-5013
(773) 984-8587
Mailing address
5828 N MAPLEWOOD AVE, CHICAGO, IL 60659-5013
(773) 984-8587
Taxonomy
Speciality
Code
Description
License number
State
347C00000X
Private Vehicle
Primary
T250-3205-424901
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
453200993
PRIVATE PROVIDER
IL
Enumeration date
11/12/2015
Last updated
11/12/2015
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