MEDICARE: ELVIRA FE BAQUIRIN BRAVO APRN

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	209034468	IL

General Provider Information

NPI Number	:	1265391809
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELVIRA FE BAQUIRIN BRAVO APRN

Provider Business Mailing Address
First Line	:	2720 W DIVISION ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-2853
Country	:	US
Telephone Number	:	773-772-7858
Fax Number	:	773-687-9539

Provider Business Practice Location Address
First Line	:	2720 W DIVISION ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-2853
Country	:	US
Telephone Number	:	773-772-7858
Fax Number	:	773-687-9539

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

Provider Enumeration Date	:	01/20/2026
Last Update Date	:	01/20/2026

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