MEDICARE: FERNANDO A AMPUERO MD

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	207VG0400X	Gynecology Physician	036066158	IL

General Provider Information

NPI Number	:	1760438477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FERNANDO A AMPUERO MD

Provider Business Mailing Address
First Line	:	PO BOX 6811
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60680-6811
Country	:	US
Telephone Number	:	773-521-6001
Fax Number	:	773-521-1154

Provider Business Practice Location Address
First Line	:	3517 W 26TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60623-3910
Country	:	US
Telephone Number	:	773-521-6001
Fax Number	:	773-521-1154

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

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	10/24/2014

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