Healthcare Provider Details

I. General information

NPI: 1174855290
Provider Name (Legal Business Name): JOSEPH J. VITEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2010
Last Update Date: 02/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 HARRISON ST
BELLWOOD IL
60104-2450
US

IV. Provider business mailing address

2615 HARRISON ST
BELLWOOD IL
60104-2450
US

V. Phone/Fax

Practice location:
  • Phone: 708-493-0199
  • Fax: 708-493-9683
Mailing address:
  • Phone: 708-493-0199
  • Fax: 708-493-9683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471N0900X
TaxonomyNuclear Medicine Technology Radiologic Technologist
License Number500493344
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: