Healthcare Provider Details

I. General information

NPI: 1952234858
Provider Name (Legal Business Name): MICHAEL VASQUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 S LOOMIS ST
CHICAGO IL
60607-2812
US

IV. Provider business mailing address

5036 S LEAMINGTON AVE
CHICAGO IL
60638-2143
US

V. Phone/Fax

Practice location:
  • Phone: 872-298-9199
  • Fax:
Mailing address:
  • Phone: 773-289-7277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: