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Organization

EVELYN G. BASCO,M.D.,S.C.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. EVELYN GANADEN BASCO M.D. (PRESIDENT)
(773) 533-3440
Entity
Organization

Contact information

Practice address
3900 W MADISON ST, CHICAGO, IL 60624-2354
(773) 533-3440
Mailing address
3900 W MADISON ST, CHICAGO, IL 60624-2354
(773) 533-3440

Taxonomy

Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
036055675
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
036055675
IL
Enumeration date
04/27/2009
Last updated
06/10/2009
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