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NPI Code Detail

MEDICARE: CARLOS H MACHICAO CRNA

MEDICARE: CARLOS H MACHICAO CRNA
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
1367500000XCertified Registered Nurse Anesthetist209003950IL

General Provider Information

NPI Number : 1730226457
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARLOS H MACHICAO CRNA
Provider Business Mailing Address
First Line : 4227 LINCOLNSHIRE DRIVE
Second Line :
City : MOUNT VERNON
State : IL
Zip : 62864-2157
Country : US
Telephone Number : 618-242-2317
Fax Number : 618-242-9710
Provider Business Practice Location Address
First Line : 605 N 12TH ST
Second Line : ANESTHESIOLOGY DEPARTMENT
City : MOUNT VERNON
State : IL
Zip : 62864-2857
Country : US
Telephone Number : 618-242-4600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/31/2007
Last Update Date : 06/04/2010

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Directions to “ CARLOS H MACHICAO CRNA” Practice Location

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