MEDICARE: MR. MIGUEL ANTONIO ESPINAL RSA-C

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	246ZC0007X	Surgical Assistant	238.000223	IL

General Provider Information

NPI Number	:	1619106440
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MIGUEL ANTONIO ESPINAL RSA-C

Provider Business Mailing Address
First Line	:	PO BOX 448
Second Line	:
City	:	HIGHLAND PARK
State	:	IL
Zip	:	60035-0448
Country	:	US
Telephone Number	:	847-917-3666
Fax Number	:	847-681-0715

Provider Business Practice Location Address
First Line	:	1587 LANCELOT AVE
Second Line	:
City	:	HIGHLAND PARK
State	:	IL
Zip	:	60035-2218
Country	:	US
Telephone Number	:	847-917-3666
Fax Number	:	847-681-0715

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

Provider Enumeration Date	:	07/14/2009
Last Update Date	:	07/14/2009

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