Healthcare Provider Details

I. General information

NPI: 1306194071
Provider Name (Legal Business Name): LUIS F GUZMAN VINASCO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2012
Last Update Date: 04/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 W. CENTRAL ROAD SUITE 8100
ARLINGTON HEIGHTS IL
60005
US

IV. Provider business mailing address

880 W. CENTRAL ROAD SUITE 8100
ARLINGTON HEIGHTS IL
60005
US

V. Phone/Fax

Practice location:
  • Phone: 847-255-5030
  • Fax: 847-255-0156
Mailing address:
  • Phone: 847-255-5030
  • Fax: 847-255-0156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number036134062
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: