MEDICARE: DR. EDUARDO JORGE ENCINAS M.D.

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	207V00000X	Obstetrics & Gynecology Physician	036060976	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	31600405	OTHER	IL	BLUE CROSS CICERO OFFC
2	363484385	OTHER	IL	TAX ID NO.
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	01619327	OTHER	IL	BLUE CROSS NO ASHLAND OFC

General Provider Information

NPI Number	:	1457430910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDUARDO JORGE ENCINAS M.D.

Provider Business Mailing Address
First Line	:	6851 LOREL AVE
Second Line	:
City	:	SKOKIE
State	:	IL
Zip	:	60077-3426
Country	:	US
Telephone Number	:	847-676-3729
Fax Number	:

Provider Business Practice Location Address
First Line	:	4608 S ASHLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60609-3251
Country	:	US
Telephone Number	:	773-927-7574
Fax Number	:	773-927-7583

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2006
Last Update Date	:	07/09/2007

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Directions to “ DR. EDUARDO JORGE ENCINAS M.D.” Practice Location

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