MEDICARE: DR. MAURICIO A CONSALTER 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	207R00000X	Internal Medicine Physician	36100573	IL
2	207R00000X	Internal Medicine Physician	036100573	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	:	1083653927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAURICIO A CONSALTER M.D.

Provider Business Mailing Address
First Line	:	355 W DUNDEE RD STE 110
Second Line	:
City	:	BUFFALO GROVE
State	:	IL
Zip	:	60089-3500
Country	:	US
Telephone Number	:	847-541-4878
Fax Number	:	847-520-0500

Provider Business Practice Location Address
First Line	:	2381 N MILWAUKEE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-2924
Country	:	US
Telephone Number	:	773-227-2687
Fax Number	:

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

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	12/22/2021

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