MEDICARE: DR. MARIO FLOR MAGLEO 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	207L00000X	Anesthesiology Physician		IL

General Provider Information

NPI Number	:	1396818118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIO FLOR MAGLEO MD

Provider Business Mailing Address
First Line	:	2717 CONNOLLY LANE
Second Line	:
City	:	WEST DUNDEE
State	:	IL
Zip	:	60118-1754
Country	:	US
Telephone Number	:	847-551-3309
Fax Number	:

Provider Business Practice Location Address
First Line	:	2701 W 68TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60629-1882
Country	:	US
Telephone Number	:	773-884-9000
Fax Number	:

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

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	07/08/2007

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