Organization
DR EVELYN G BASCO MD, SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LILYFLOR G JOSE (ADM ASSIST)
(773) 737-8818
Entity
Organization
Contact information
Practice address
3900 W MADISON ST, CHICAGO, IL 60624-2354
(773) 533-3440
(773) 884-8117
Mailing address
3900 W MADISON ST, CHICAGO, IL 60624-2354
(773) 533-3440
(773) 884-8117
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
036055675
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036055675
—
IL
01
—
1235373853
GROUP NPI
—
Enumeration date
04/24/2008
Last updated
08/12/2009
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