MEDICARE: MR. AMERICO GUNDEMARO CALDERON

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	171R00000X	Interpreter

General Provider Information

NPI Number	:	1316115330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. AMERICO GUNDEMARO CALDERON

Provider Business Mailing Address
First Line	:	3156 S WALLACE ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-3029
Country	:	US
Telephone Number	:	773-407-9739
Fax Number	:

Provider Business Practice Location Address
First Line	:	3156 S WALLACE ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-3029
Country	:	US
Telephone Number	:	773-407-9739
Fax Number	:

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

Provider Enumeration Date	:	02/12/2008
Last Update Date	:	02/12/2008

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