MEDICARE: DR. NANETTE Y. FABI 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	207R00000X	Internal Medicine Physician	036089814	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	F400460536	OTHER	IL	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	110139210	OTHER	IL	RRM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548269228
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NANETTE Y. FABI M.D.

Provider Business Mailing Address
First Line	:	27702 NETWORK PL
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60673-1277
Country	:	US
Telephone Number	:	708-862-7674
Fax Number	:	708-862-1781

Provider Business Practice Location Address
First Line	:	18127 WILLIAM ST
Second Line	:
City	:	LANSING
State	:	IL
Zip	:	60438-3921
Country	:	US
Telephone Number	:	708-474-8844
Fax Number	:	708-474-6135

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

Provider Enumeration Date	:	07/15/2005
Last Update Date	:	12/19/2018

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