MEDICARE: ALFREDO P. SY 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	207Q00000X	Family Medicine Physician	036056112	IL

General Provider Information

NPI Number	:	1184658643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALFREDO P. SY M.D.

Provider Business Mailing Address
First Line	:	3910 CAROUSEL DR
Second Line	:
City	:	NORTHBROOK
State	:	IL
Zip	:	60062-7535
Country	:	US
Telephone Number	:	773-292-8300
Fax Number	:	773-292-2601

Provider Business Practice Location Address
First Line	:	1044 N MOZART ST
Second Line	:	SUITE 203
City	:	CHICAGO
State	:	IL
Zip	:	60622-2789
Country	:	US
Telephone Number	:	773-292-8300
Fax Number	:

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

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	12/10/2010

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