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NPI Code Detail

MEDICARE: MARIA TERESA DAVILA RDMS

MEDICARE:   MARIA TERESA DAVILA  RDMS
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
12471S1302XSonography Radiologic Technologist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11616020OTHERILBC/BS

General Provider Information

NPI Number : 1578652897
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIA TERESA DAVILA RDMS
Provider Business Mailing Address
First Line : 9034 SO ESCANABA AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60617
Country : US
Telephone Number : 773-768-7558
Fax Number :
Provider Business Practice Location Address
First Line : 1725 W HARRISON ST
Second Line : SUITE 408
City : CHICAGO
State : IL
Zip : 60612
Country : US
Telephone Number : 312-997-2229
Fax Number : 312-666-4163
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/12/2006
Last Update Date : 07/08/2007

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Directions to “ MARIA TERESA DAVILA RDMS” Practice Location

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