Healthcare Provider Details

I. General information

NPI: 1265455653
Provider Name (Legal Business Name): VIVIANA PLOPER MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: VIVIANA MORGAN

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 12/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4740 N CLARK ST
CHICAGO IL
60640-4689
US

IV. Provider business mailing address

5855 N SHERIDAN RD APT. 12 C
CHICAGO IL
60660-3818
US

V. Phone/Fax

Practice location:
  • Phone: 773-765-0820
  • Fax: 773-765-0839
Mailing address:
  • Phone: 773-765-0820
  • Fax: 773-765-0839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: