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General NPI Number Information
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NPI Number | 1568558815
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Entity Type | Organization
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Legal Business Name | DR MARIO OLIVEROS P.C.
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 5015 N PAULINA ST SUITE 218
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City | CHICAGO
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State | IL
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Zip | 60640-2756
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Country | US
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Telephone | 773-334-8500
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Fax |
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Provider Business Mailing Address
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Address Line | 5015 N PAULINA ST SUITE 218
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City | CHICAGO
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State | IL
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Zip | 60640-2756
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Country | US
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Telephone | 773-334-8500
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARIO E OLIVEROS
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Credential | M.D.
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Telephone | 773-334-8500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number |
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License Number State |
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