MEDICARE: DR. RICARDO N NABONG 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	208800000X	Urology Physician	036052875	IL

General Provider Information

NPI Number	:	1578596193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICARDO N NABONG M.D.

Provider Business Mailing Address
First Line	:	4318 W CRYSTAL LAKE RD STE G
Second Line	:
City	:	MCHENRY
State	:	IL
Zip	:	60050-4250
Country	:	US
Telephone Number	:	815-344-0734
Fax Number	:	815-344-0485

Provider Business Practice Location Address
First Line	:	4318 W CRYSTAL LAKE RD STE G
Second Line	:
City	:	MCHENRY
State	:	IL
Zip	:	60050-4250
Country	:	US
Telephone Number	:	815-344-0734
Fax Number	:	815-344-0485

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

Provider Enumeration Date	:	07/08/2006
Last Update Date	:	02/17/2010

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