MEDICARE: DR. BIENVENIDO TECSON LAMORENA 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	207K00000X	Allergy & Immunology Physician		IL

General Provider Information

NPI Number	:	1265502231
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BIENVENIDO TECSON LAMORENA MD

Provider Business Mailing Address
First Line	:	9336 NATCHEZ AVE
Second Line	:
City	:	MORTON GROVE
State	:	IL
Zip	:	60053-1445
Country	:	US
Telephone Number	:	773-777-9400
Fax Number	:	773-777-6917

Provider Business Practice Location Address
First Line	:	5356 W DIVERSEY AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60639-1513
Country	:	US
Telephone Number	:	773-777-9400
Fax Number	:	773-777-6917

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

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	07/08/2007

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