MEDICARE: DR. MARIA CONCEPCION REYES 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	207R00000X	Internal Medicine Physician	036092865	IL

General Provider Information

NPI Number	:	1508805029
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIA CONCEPCION REYES M.D.

Provider Business Mailing Address
First Line	:	1300 W BELMONT AVE
Second Line	:	SUITE 100
City	:	CHICAGO
State	:	IL
Zip	:	60657-3200
Country	:	US
Telephone Number	:	773-975-8900
Fax Number	:	773-975-8901

Provider Business Practice Location Address
First Line	:	1300 W BELMONT AVE
Second Line	:	SUITE 100
City	:	CHICAGO
State	:	IL
Zip	:	60657-3200
Country	:	US
Telephone Number	:	773-975-8900
Fax Number	:	773-975-8901

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

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	01/13/2015

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