MEDICARE: MARIBE FE BANGAYAN 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	207R00000X	Internal Medicine Physician	036100866	IL
2	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	036100866	IL
3	207RP1001X	Pulmonary Disease Physician	036100866	IL

Other Identifiers

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

General Provider Information

NPI Number	:	1982602629
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIBE FE BANGAYAN MD

Provider Business Mailing Address
First Line	:	5140 N. CALIFORNIA AVE.
Second Line	:	SUITE 740-GMP
City	:	CHICAGO
State	:	IL
Zip	:	60625
Country	:	US
Telephone Number	:	773-989-3957
Fax Number	:	773-989-3971

Provider Business Practice Location Address
First Line	:	4640 N MARINE DR
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-5719
Country	:	US
Telephone Number	:	773-564-5577
Fax Number	:	773-564-5578

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	04/30/2021

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Directions to “ MARIBE FE BANGAYAN MD” Practice Location

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