Healthcare Provider Details

I. General information

NPI: 1790787299
Provider Name (Legal Business Name): LALAINE DURAL VITUG-PACIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LALAINE DURAL VITUG MD

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 02/04/2020
Certification Date: 02/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1614 W. CENTRAL ROAD SUITE 209
ARLINGTON HEIGHTS IL
60005
US

IV. Provider business mailing address

1614 W. CENTRAL ROAD SUITE 209
ARLINGTON HEIGHTS IL
60005
US

V. Phone/Fax

Practice location:
  • Phone: 847-259-5070
  • Fax: 847-259-5322
Mailing address:
  • Phone: 847-259-5070
  • Fax: 847-259-5322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036-087254
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: