MEDICARE: CARMEN A. SIERRA M.D.,S.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	174400000X	Specialist		IL

General Provider Information

NPI Number	:	1780870832
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARMEN A. SIERRA M.D.,S.C.

Provider Business Mailing Address
First Line	:	1349 N WESTERN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-8316
Country	:	US
Telephone Number	:	773-384-8584
Fax Number	:	773-661-0921

Provider Business Practice Location Address
First Line	:	1349 N WESTERN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-8316
Country	:	US
Telephone Number	:	773-384-8584
Fax Number	:	773-661-0921

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CARMEN ANA SIERRA
Credential	:	M.D.
Telephone Number	:	773-384-8584

Provider Enumeration Date	:	09/22/2007
Last Update Date	:	09/22/2007

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