MEDICARE: IGIA FIRST INC.

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	207Q00000X	Family Medicine Physician	036123281	IL

General Provider Information

NPI Number	:	1518300771
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IGIA FIRST INC.

Provider Business Mailing Address
First Line	:	5781 N LINCOLN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-4722
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5781 N LINCOLN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-4722
Country	:	US
Telephone Number	:	773-942-7428
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. TERESA BLANCO
Credential	:
Telephone Number	:	773-942-7428

Provider Enumeration Date	:	04/08/2013
Last Update Date	:	07/08/2013

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