MEDICARE: RICARDO N. NABONG, M.D.,S.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	208800000X	Urology Physician	036052875	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1578596193	OTHER	IL	NPI#

General Provider Information

NPI Number	:	1730211475
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICARDO N. NABONG, M.D.,S.C.

Provider Business Mailing Address
First Line	:	4318 W CRYSTAL LAKE RD
Second Line	:	SUITE G
City	:	MCHENRY
State	:	IL
Zip	:	60050-4210
Country	:	US
Telephone Number	:	815-344-0734
Fax Number	:	815-344-0485

Provider Business Practice Location Address
First Line	:	4318 W CRYSTAL LAKE RD
Second Line	:	SUITE G
City	:	MCHENRY
State	:	IL
Zip	:	60050-4210
Country	:	US
Telephone Number	:	815-344-0734
Fax Number	:	815-344-0485

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	CAROLYN ANNE NABONG
Credential	:	R.N.
Telephone Number	:	815-344-0734

Provider Enumeration Date	:	03/09/2007
Last Update Date	:	03/03/2011

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