MEDICARE: ARLENE OBAZEE PA C

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	363A00000X	Physician Assistant	1059376	IL

General Provider Information

NPI Number	:	1639272727
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARLENE OBAZEE PA C

Provider Business Mailing Address
First Line	:	4621 FARMINGTON AVE
Second Line	:
City	:	RICHTON PARK
State	:	IL
Zip	:	60471-1807
Country	:	US
Telephone Number	:	708-503-0455
Fax Number	:	773-643-0640

Provider Business Practice Location Address
First Line	:	5517 S MICHIGAN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60637-1012
Country	:	US
Telephone Number	:	773-643-0400
Fax Number	:	773-643-0640

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

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	07/24/2007

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