MEDICARE: MRS. GRACE CATHERINE ALCARAZ PA-C

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	363A00000X	Physician Assistant	085004762	IL

General Provider Information

NPI Number	:	1356864698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GRACE CATHERINE ALCARAZ PA-C

Provider Business Mailing Address
First Line	:	4608 N LOWELL AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-4016
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1349 N WESTERN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-8316
Country	:	US
Telephone Number	:	773-384-8584
Fax Number	:

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

Provider Enumeration Date	:	07/19/2017
Last Update Date	:	07/19/2017

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