MEDICARE: MARIA SOBRERO MD

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	207RN0300X	Nephrology Physician	036072521	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
2	01615184	OTHER	IL	BCBS

General Provider Information

NPI Number	:	1255318879
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA SOBRERO MD

Provider Business Mailing Address
First Line	:	210 S DESPLAINES ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60661-5500
Country	:	US
Telephone Number	:	312-654-2700
Fax Number	:	312-654-9930

Provider Business Practice Location Address
First Line	:	2555 S KING DR
Second Line	:	2ND FLR
City	:	CHICAGO
State	:	IL
Zip	:	60616-2419
Country	:	US
Telephone Number	:	312-379-8022
Fax Number	:	312-674-4001

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

Provider Enumeration Date	:	12/23/2005
Last Update Date	:	05/09/2013

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Directions to “ MARIA SOBRERO MD” Practice Location

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