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NPI Code Detail

MEDICARE: VISTA FAMILY MEDICINE INC

MEDICARE: VISTA FAMILY MEDICINE INC
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
1207Q00000XFamily Medicine Physician

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2DF2121OTHERILMEDICARE RAILROAD (GROUP)
3P00347253OTHERILMEDICARE RAILROAD (VALEK)

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11053305557OTHERILPROVIDER NPI
41235321704OTHERILPROVIDER NPI

General Provider Information

NPI Number : 1144214644
Entity Type Code : Organization
Provider Name (Legal Business Name) : VISTA FAMILY MEDICINE INC
Provider Business Mailing Address
First Line : 10961 S KEDZIE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60655-2219
Country : US
Telephone Number : 773-239-9100
Fax Number : 773-239-9102
Provider Business Practice Location Address
First Line : 10961 S KEDZIE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60655-2219
Country : US
Telephone Number : 773-239-9100
Fax Number : 773-239-9102
Authorized Official
Title or Position : PRESIDENT
Name : DR. JAMES PAUL VALEK
Credential : M.D.
Telephone Number : 773-239-9100
Provider Enumeration Date : 09/12/2005
Last Update Date : 04/01/2008

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Directions to “VISTA FAMILY MEDICINE INC ” Practice Location

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