MEDICARE: DR. CARLOS RAFAEL DA FONSECA 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	207Q00000X	Family Medicine Physician	036-122089	IL

General Provider Information

NPI Number	:	1578799748
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARLOS RAFAEL DA FONSECA M.D

Provider Business Mailing Address
First Line	:	2901 W TOUHY AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60645-2937
Country	:	US
Telephone Number	:	773-973-7350
Fax Number	:	773-973-0506

Provider Business Practice Location Address
First Line	:	2901 W TOUHY AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60645-2937
Country	:	US
Telephone Number	:	773-973-7350
Fax Number	:	773-973-0506

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

Provider Enumeration Date	:	06/02/2009
Last Update Date	:	06/02/2009

Similar Medicare Providers

1144307596 — SINAI TOUCHY PHARMACY L L C
Practice Location Address:

2907 W TOUHY AVE
CHICAGO, IL
60645-2937

Practice Phone: 773-274-3593
Practice Fax: 773-274-3741

1952449456 — MOUNT SINAI COMMUNITY FOUNDATION
Practice Location Address:

2901 W TOUHY AVE
CHICAGO, IL
60645-2937

Practice Phone: 773-973-7350
Practice Fax:

1982800306 — MS. MARINA ELYASH PA-C
Practice Location Address:

2901 W TOUHY AVE
CHICAGO, IL
60645-2937

Practice Phone: 773-973-7350
Practice Fax:

1366609125 — DR. LUKA BUNDALO DDS
Practice Location Address:

2925 W TOUHY AVE
CHICAGO, IL
60645-2937

Practice Phone: 773-465-2600
Practice Fax: 773-465-2724

1518410794 — MARK HAGERTY
Practice Location Address:

2901 W TOUHY AVE
CHICAGO, IL
60645-2937

Practice Phone: 773-973-7350
Practice Fax: 773-973-0506

1689167298 — MARIE JEAN BRIKHA DMD
Practice Location Address:

2925 W TOUHY AVE
CHICAGO, IL
60645-2937

Practice Phone: 773-465-2600
Practice Fax:

Directions to “ DR. CARLOS RAFAEL DA FONSECA M.D” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.