MEDICARE: DR. ANASTACIA R LARGOSA 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	207Q00000X	Family Medicine Physician	036057514	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750329835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANASTACIA R LARGOSA M.D.

Provider Business Mailing Address
First Line	:	10448 S PULASKI RD
Second Line	:
City	:	OAK LAWN
State	:	IL
Zip	:	60453-4895
Country	:	US
Telephone Number	:	708-424-7705
Fax Number	:	708-424-0502

Provider Business Practice Location Address
First Line	:	10448 S PULASKI RD
Second Line	:
City	:	OAK LAWN
State	:	IL
Zip	:	60453-4895
Country	:	US
Telephone Number	:	708-424-7705
Fax Number	:	708-424-0502

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

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	01/03/2014

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