MEDICARE: DR. MYRNA M PATRICIO MD

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	207Q00000X	Family Medicine Physician	036092352	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720080534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MYRNA M PATRICIO MD

Provider Business Mailing Address
First Line	:	1431 N WESTERN AVE
Second Line	:	STE 201
City	:	CHICAGO
State	:	IL
Zip	:	60622-7712
Country	:	US
Telephone Number	:	773-276-2272
Fax Number	:	773-276-2399

Provider Business Practice Location Address
First Line	:	1431 N WESTERN AVE
Second Line	:	#101
City	:	CHICAGO
State	:	IL
Zip	:	60622-1797
Country	:	US
Telephone Number	:	773-276-2272
Fax Number	:	773-276-2399

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

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	07/24/2018

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