MEDICARE: DR. RODRIGO F ENDARA M.D.

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	261QP2300X	Primary Care Clinic/Center		IL

General Provider Information

NPI Number	:	1811909963
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RODRIGO F ENDARA M.D.

Provider Business Mailing Address
First Line	:	1417 N ASHLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-2224
Country	:	US
Telephone Number	:	773-342-1090
Fax Number	:	773-342-5249

Provider Business Practice Location Address
First Line	:	1417 N ASHLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-2224
Country	:	US
Telephone Number	:	773-342-1090
Fax Number	:	773-342-5249

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

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	07/08/2007

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