MEDICARE: MRS. MARIA MANUEL-RUBIO APN

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	208000000X	Pediatrics Physician		IL

General Provider Information

NPI Number	:	1093763799
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARIA MANUEL-RUBIO APN

Provider Business Mailing Address
First Line	:	2300 CHILDRENS PLAZA
Second Line	:	DEPARTMENT OF GASTROENTEROLOGY BOX #65
City	:	CHICAGO
State	:	IL
Zip	:	60614
Country	:	US
Telephone Number	:	773-880-4354
Fax Number	:	773-880-4036

Provider Business Practice Location Address
First Line	:	2515 N CLARK ST
Second Line	:	SUITE 905
City	:	CHICAGO
State	:	IL
Zip	:	60614
Country	:	US
Telephone Number	:	773-327-2021
Fax Number	:	773-327-1922

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

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	07/08/2007

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