MEDICARE: AUGUSTO N. PAREJA MD SC

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	207Q00000X	Family Medicine Physician	036.065907	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033392535
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUGUSTO N. PAREJA MD SC

Provider Business Mailing Address
First Line	:	3232 W 55TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60632-2638
Country	:	US
Telephone Number	:	773-434-8026
Fax Number	:	773-434-8107

Provider Business Practice Location Address
First Line	:	3232 W 55TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60632-2638
Country	:	US
Telephone Number	:	773-434-8026
Fax Number	:	773-434-8107

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. AUGUSTO N PAREJA
Credential	:	MD
Telephone Number	:	773-434-8026

Provider Enumeration Date	:	12/07/2007
Last Update Date	:	06/22/2012

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