MEDICARE: DR. SARGON AUDISHO

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	2083P0901X	Public Health & General Preventive Medicine Physician	036132241	IL

General Provider Information

NPI Number	:	1568690899
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SARGON AUDISHO

Provider Business Mailing Address
First Line	:	890 E HIGGINS RD
Second Line	:	SUITE 113A
City	:	SCHAUMBURG
State	:	IL
Zip	:	60173-4799
Country	:	US
Telephone Number	:	224-653-9000
Fax Number	:

Provider Business Practice Location Address
First Line	:	4143 N CLAREMONT AVE
Second Line	:	APT 2
City	:	CHICAGO
State	:	IL
Zip	:	60618-2919
Country	:	US
Telephone Number	:	312-218-1204
Fax Number	:

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

Provider Enumeration Date	:	06/25/2009
Last Update Date	:	07/18/2013

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