Healthcare Provider Details

I. General information

NPI: 1255844288
Provider Name (Legal Business Name): FRANCISCO ABANCO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2017
Last Update Date: 03/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 W TAYLOR ST
CHICAGO IL
60612-7232
US

IV. Provider business mailing address

4846 N CLARK ST APT 306
CHICAGO IL
60640-7922
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-4020
  • Fax: 312-996-4019
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209017220
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number041357981
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: