Individual
DR. EVELYN GANADEN BASCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3900 W MADISON, CHICAGO, IL 60624
(773) 533-3440
(773) 722-1200
Mailing address
3900 W MADISON, CHICAGO, IL 60624
(773) 533-3440
(773) 722-1200
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
36-055675
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036055675
—
IL
Enumeration date
12/06/2006
Last updated
07/08/2007
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