MEDICARE: NANCY R. SAGONA 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	2085R0202X	Diagnostic Radiology Physician		IL

General Provider Information

NPI Number	:	1679574461
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY R. SAGONA M.D.

Provider Business Mailing Address
First Line	:	520 E 22ND ST
Second Line	:
City	:	LOMBARD
State	:	IL
Zip	:	60148-6110
Country	:	US
Telephone Number	:	630-874-2542
Fax Number	:	630-874-2642

Provider Business Practice Location Address
First Line	:	3701 DOTY RD
Second Line	:	MEMORIAL MEDICAL CENTER / RADIOLOGY DEPAR
City	:	WOODSTOCK
State	:	IL
Zip	:	60098-7509
Country	:	US
Telephone Number	:	815-338-2500
Fax Number	:	815-334-3066

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

Provider Enumeration Date	:	08/03/2005
Last Update Date	:	07/08/2007

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