MEDICARE: MILDRED ABONCE MT

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	225700000X	Massage Therapist	227007446	IL

General Provider Information

NPI Number	:	1245499565
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MILDRED ABONCE MT

Provider Business Mailing Address
First Line	:	2806 W TOUHY AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60645-2902
Country	:	US
Telephone Number	:	773-856-6889
Fax Number	:	615-858-6889

Provider Business Practice Location Address
First Line	:	2806 W TOUHY AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60645-2902
Country	:	US
Telephone Number	:	773-856-6889
Fax Number	:	615-858-6889

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

Provider Enumeration Date	:	06/02/2008
Last Update Date	:	06/02/2008

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Directions to “ MILDRED ABONCE MT” Practice Location

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