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NPI Code Detail

MEDICARE: CECELIA B BACOM CNM

MEDICARE: CECELIA B BACOM CNM
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
1367A00000XAdvanced Practice Midwife209001981IL

Other Identifiers

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

General Provider Information

NPI Number : 1932141637
Entity Type Code : Individual
Provider Name (Legal Business Name) : CECELIA B BACOM CNM
Provider Business Mailing Address
First Line : 6201 ROOSEVELT RD
Second Line :
City : BERWYN
State : IL
Zip : 60402-1108
Country : US
Telephone Number : 708-386-0845
Fax Number : 708-386-8472
Provider Business Practice Location Address
First Line : 6201 ROOSEVELT RD
Second Line :
City : BERWYN
State : IL
Zip : 60402-1108
Country : US
Telephone Number : 708-386-0845
Fax Number : 708-386-8472
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2006
Last Update Date : 12/23/2019

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Directions to “ CECELIA B BACOM CNM” Practice Location

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