Individual
CARLOS H MACHICAO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
605 N 12TH ST, ANESTHESIOLOGY DEPARTMENT, MOUNT VERNON, IL 62864-2857
(618) 242-4600
Mailing address
4227 LINCOLNSHIRE DRIVE, MOUNT VERNON, IL 62864-2157
(618) 242-2317
(618) 242-9710
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
209003950
IL
Other
Enumeration date
01/31/2007
Last updated
06/04/2010
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