MEDICARE: DR. LOURDES MELLA HILAO M.D.

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	2083P0901X	Public Health & General Preventive Medicine Physician		IL

General Provider Information

NPI Number	:	1073727400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LOURDES MELLA HILAO M.D.

Provider Business Mailing Address
First Line	:	200 E 115TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60628-5015
Country	:	US
Telephone Number	:	312-747-2823
Fax Number	:	312-747-2851

Provider Business Practice Location Address
First Line	:	4243 W FULLERTON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60639-2049
Country	:	US
Telephone Number	:	773-489-5110
Fax Number	:	773-489-5111

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	07/08/2007

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