Individual ProviderMary Beth ObesoFamily MedicineAllopathic & Osteopathic PhysiciansPractice Address1100 Lake St, Suite 210, Oak Park, IL 60301-1015(708) 848-4188(708) 524-2131PECOS EnrollmentBased on the most recent information from CMS, provider Mary Beth Obeso is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 5 days ago.Profile DetailsProvider ID1760461818Provider TypeIndividualFull NameObeso, Mary BethCredentialMDGenderFemaleSole ProprietorNoEnumeration Date1/16/2006Last Updated3/24/2021Contact InformationPractice LocationPractice Address1100 Lake St, Suite 210, Oak Park, IL 60301-1015Phone(708) 848-4188Fax(708) 524-2142Mailing LocationMailing Address1100 Lake St, Suite 210, Oak Park, IL 60301-1015Phone(708) 524-2131Fax(708) 524-2142Provider TaxonomiesCodeDescriptionLicenseCode207Q00000XPrimaryDescriptionFamily MedicineAllopathic & Osteopathic PhysiciansLicense036095647IllinoisProvider IdentifiersIDDescriptionIssuerID01615849DescriptionOtherIssuerBCBSIllinoisID036095647DescriptionMedicaidIssuerUnlistedIllinois