MEDICARE: VITAL LINK PHYSICIAN GROUP PLLC

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	171M00000X	Case Manager/Care Coordinator
2	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1679311336
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VITAL LINK PHYSICIAN GROUP PLLC

Provider Business Mailing Address
First Line	:	6201 W HOWARD ST
Second Line	:
City	:	NILES
State	:	IL
Zip	:	60714-3436
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6201 W HOWARD ST
Second Line	:
City	:	NILES
State	:	IL
Zip	:	60714-3436
Country	:	US
Telephone Number	:	847-774-7316
Fax Number	:

Authorized Official
Title or Position	:	MANAGEMENT
Name	:	EMANUEL ATKIN
Credential	:
Telephone Number	:	847-774-7316

Provider Enumeration Date	:	07/17/2024
Last Update Date	:	04/20/2026

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