Healthcare Provider Details

I. General information

NPI: 1659611549
Provider Name (Legal Business Name): FRANCISCO DANIEL MAHECHA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2013
Last Update Date: 02/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5628 N KEYSTONE AVE
CHICAGO IL
60646-6713
US

IV. Provider business mailing address

5628 N KEYSTONE AVE
CHICAGO IL
60646-6713
US

V. Phone/Fax

Practice location:
  • Phone: 773-712-3289
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: