Healthcare Provider Details

I. General information

NPI: 1114214111
Provider Name (Legal Business Name): CHUCK RICHARD VRASICH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2011
Last Update Date: 10/05/2021
Certification Date: 10/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 S MCHENRY RD
BUFFALO GROVE IL
60089-6705
US

IV. Provider business mailing address

15 S MCHENRY RD
BUFFALO GROVE IL
60089-6705
US

V. Phone/Fax

Practice location:
  • Phone: 847-618-0351
  • Fax: 847-618-0766
Mailing address:
  • Phone: 847-618-0351
  • Fax: 847-618-0766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0078759
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: