MEDICARE: DR. IRENE EFTEKHAR M.D.

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	2080P0207X	Pediatric Hematology & Oncology Physician	036-059992	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	E24704	OTHER	IL	MEDICARE ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326014077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IRENE EFTEKHAR M.D.

Provider Business Mailing Address
First Line	:	840 S WOOD ST # MC856
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-4325
Country	:	US
Telephone Number	:	312-996-7416
Fax Number	:	312-413-0243

Provider Business Practice Location Address
First Line	:	1801 W TAYLOR ST STE 2E
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-4795
Country	:	US
Telephone Number	:	312-996-7416
Fax Number	:	312-413-8778

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

Provider Enumeration Date	:	02/23/2006
Last Update Date	:	04/24/2013

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