MEDICARE: HEBERT TASCON INC

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	347C00000X	Private Vehicle	T250-3205-424901	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	453200993	OTHER	IL	PRIVATE PROVIDER

General Provider Information

NPI Number	:	1164895165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEBERT TASCON INC

Provider Business Mailing Address
First Line	:	5828 N MAPLEWOOD AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-5013
Country	:	US
Telephone Number	:	773-984-8587
Fax Number	:

Provider Business Practice Location Address
First Line	:	5828 N MAPLEWOOD AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-5013
Country	:	US
Telephone Number	:	773-984-8587
Fax Number	:

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

Provider Enumeration Date	:	11/12/2015
Last Update Date	:	11/12/2015

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Directions to “ HEBERT TASCON INC” Practice Location

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