| Organization Name: | DR EVELYN G BASCO MD, SC |
| NPI Number: | 1629243282 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LILYFLOR G JOSE (ADM ASSIST) |
| Mailing Address: | 3900 W Madison St Chicago |
| State: | IL US |
| Postal Code: | 606242354 |
| Phone Number: | 7735333440 |
| Fax Number: | 7738848117 |
| NPI Enumeration Date: | 04/24/2008 |
| NPI Last Update Date: | 08/12/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 036055675 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |