MEDICARE: R DEVA NATHAN MD SC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0003X	Hematology & Oncology Physician

General Provider Information

NPI Number	:	1346341336
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	R DEVA NATHAN MD SC

Provider Business Mailing Address
First Line	:	3800 N CENTRAL AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634-2718
Country	:	US
Telephone Number	:	773-205-8415
Fax Number	:	773-205-8436

Provider Business Practice Location Address
First Line	:	3800 N CENTRAL AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634-2718
Country	:	US
Telephone Number	:	773-205-8415
Fax Number	:	773-205-8436

Authorized Official
Title or Position	:	MD PRESIDENT
Name	:	R DEVA NATHAN
Credential	:	MD
Telephone Number	:	773-205-8415

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	02/10/2010

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