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NPI Code Detail

MEDICARE: MS. ANN GARCELON M.D.

MEDICARE: MS. ANN GARCELON 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
1207R00000XInternal Medicine PhysicianIL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
101621679OTHERILBCBS OF IL

General Provider Information

NPI Number : 1750364212
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ANN GARCELON M.D.
Provider Business Mailing Address
First Line : 2525 S MICHIGAN AVE
Second Line : B-390
City : CHICAGO
State : IL
Zip : 60616-2333
Country : US
Telephone Number : 312-567-6691
Fax Number : 312-328-7895
Provider Business Practice Location Address
First Line : 5525 S PULASKI RD
Second Line : 2ND FLR
City : CHICAGO
State : IL
Zip : 60629-4417
Country : US
Telephone Number : 773-585-1955
Fax Number : 773-284-5268
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/29/2005
Last Update Date : 07/08/2007

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