MEDICARE: FERNANDO CINTA MD SC

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	208D00000X	General Practice Physician	36-34969	IL

General Provider Information

NPI Number	:	1790011146
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FERNANDO CINTA MD SC

Provider Business Mailing Address
First Line	:	2012 S ASHLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-2906
Country	:	US
Telephone Number	:	312-666-7533
Fax Number	:	312-666-6967

Provider Business Practice Location Address
First Line	:	2012 S ASHLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-2906
Country	:	US
Telephone Number	:	312-666-7533
Fax Number	:	312-666-6967

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	FERNANDO CINTA
Credential	:
Telephone Number	:	312-666-7533

Provider Enumeration Date	:	10/20/2009
Last Update Date	:	10/20/2009

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