MEDICARE: NEOCARE OF THE QUAD CITIES

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	174400000X	Specialist	036068081	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	08119960	OTHER	IL	BCBS

General Provider Information

NPI Number	:	1427294768
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEOCARE OF THE QUAD CITIES

Provider Business Mailing Address
First Line	:	2066 SOLUTIONS CTR
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-2000
Country	:	US
Telephone Number	:	309-736-4170
Fax Number	:	309-736-5079

Provider Business Practice Location Address
First Line	:	2066 SOLUTIONS CTR
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-2000
Country	:	US
Telephone Number	:	309-736-4170
Fax Number	:	309-736-5079

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ARLED IZQUIERDO
Credential	:	MD
Telephone Number	:	309-736-4170

Provider Enumeration Date	:	12/16/2008
Last Update Date	:	12/16/2008

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Directions to “NEOCARE OF THE QUAD CITIES ” Practice Location

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