MEDICARE: SANDRA L FALLICO

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	2085R0202X	Diagnostic Radiology Physician	036077396	IL

General Provider Information

NPI Number	:	1831139823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA L FALLICO

Provider Business Mailing Address
First Line	:	800 BIESTERFIELD RD
Second Line	:	ELK GROVE RADIOLOGY
City	:	ELK GROVE VLG
State	:	IL
Zip	:	60007-3311
Country	:	US
Telephone Number	:	847-956-5124
Fax Number	:	847-952-7912

Provider Business Practice Location Address
First Line	:	800 BIESTERFIELD RD
Second Line	:	ELK GROVE RADIOLOGY
City	:	ELK GROVE VLG
State	:	IL
Zip	:	60007-3311
Country	:	US
Telephone Number	:	847-956-5124
Fax Number	:	847-952-7912

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

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	03/04/2014

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Directions to “ SANDRA L FALLICO ” Practice Location

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