MEDICARE: ROLANDO A LARA MD SC

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	207R00000X	Internal Medicine Physician	036046977	IL

General Provider Information

NPI Number	:	1679895569
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROLANDO A LARA MD SC

Provider Business Mailing Address
First Line	:	1708 W 47TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60609-3822
Country	:	US
Telephone Number	:	773-927-9774
Fax Number	:

Provider Business Practice Location Address
First Line	:	1708 W 47TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60609-3822
Country	:	US
Telephone Number	:	773-927-9774
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROLANDO LARA
Credential	:	M.D.
Telephone Number	:	773-927-9774

Provider Enumeration Date	:	02/19/2010
Last Update Date	:	04/30/2010

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