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NPI Code Detail

MEDICARE: GRACE BASCOS PA-C

MEDICARE: GRACE BASCOS PA-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
1363A00000XPhysician Assistant085011345IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1085011345OTHERIL085011345

General Provider Information

NPI Number : 1619770534
Entity Type Code : Individual
Provider Name (Legal Business Name) : GRACE BASCOS PA-C
Provider Business Mailing Address
First Line : 5145 N CALIFORNIA AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60625-3661
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5145 N CALIFORNIA AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60625-3661
Country : US
Telephone Number : 773-878-8200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/27/2025
Last Update Date : 03/19/2026

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Directions to “ GRACE BASCOS PA-C” Practice Location

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