MEDICARE: PRISCO I. OLAYA JR. M.D. S.C.

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	207R00000X	Internal Medicine Physician	036048022	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	021607326	OTHER	IL	BLUE CROSS/BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033131974
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRISCO I. OLAYA JR. M.D. S.C.

Provider Business Mailing Address
First Line	:	6222 S PULASKI RD
Second Line	:	STE 2
City	:	CHICAGO
State	:	IL
Zip	:	60629-4610
Country	:	US
Telephone Number	:	773-581-8080
Fax Number	:

Provider Business Practice Location Address
First Line	:	6222 S PULASKI RD
Second Line	:	STE 2
City	:	CHICAGO
State	:	IL
Zip	:	60629-4610
Country	:	US
Telephone Number	:	773-581-8080
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PRISCO I OLAYA JR.
Credential	:	M.D.
Telephone Number	:	773-581-8080

Provider Enumeration Date	:	07/23/2006
Last Update Date	:	03/07/2023

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