MEDICARE: EVELYN GRACE NARTATEZ SERAG 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	207Q00000X	Family Medicine Physician	MD449536	PA
2	390200000X	Student in an Organized Health Care Education/Training Program
3	207Q00000X	Family Medicine Physician	036141851	IL

General Provider Information

NPI Number	:	1801101720
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVELYN GRACE NARTATEZ SERAG MD

Provider Business Mailing Address
First Line	:	3224 W ARMITAGE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-3716
Country	:	US
Telephone Number	:	773-645-0096
Fax Number	:	773-645-0113

Provider Business Practice Location Address
First Line	:	3224 W ARMITAGE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-3716
Country	:	US
Telephone Number	:	773-645-0096
Fax Number	:	773-645-0113

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

Provider Enumeration Date	:	08/16/2010
Last Update Date	:	01/13/2023

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