Provider Demographics
NPI:1164895165
Name:TASCON, HEBERT (INC)
Entity Type:Individual
Prefix:
First Name:HEBERT
Middle Name:
Last Name:TASCON
Suffix:
Gender:M
Credentials:INC
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:B
Other - Last Name:TASCON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:INC
Mailing Address - Street 1:5828 N MAPLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-5013
Mailing Address - Country:US
Mailing Address - Phone:773-984-8587
Mailing Address - Fax:
Practice Address - Street 1:5828 N MAPLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-5013
Practice Address - Country:US
Practice Address - Phone:773-984-8587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-12
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIT250-3205-424901347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL453200993OtherPRIVATE PROVIDER