Healthcare Provider Details

I. General information

NPI: 1346094190
Provider Name (Legal Business Name): MVC IL, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2024
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 W CENTRAL RD STE 104
ARLINGTON HEIGHTS IL
60005-2465
US

IV. Provider business mailing address

7125 ORCHARD LAKE RD STE 316
WEST BLOOMFIELD MI
48322-3629
US

V. Phone/Fax

Practice location:
  • Phone: 866-607-2308
  • Fax: 248-855-5455
Mailing address:
  • Phone: 866-607-2308
  • Fax: 248-855-5455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MATT KIRK
Title or Position: CHIEF REVENUE OFFICER
Credential:
Phone: 708-710-9931