Healthcare Provider Details

I. General information

NPI: 1992934673
Provider Name (Legal Business Name): REMEGIO M VILBAR MDSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2009
Last Update Date: 07/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1431 N WESTERN AVE STE 202
CHICAGO IL
60622-7712
US

IV. Provider business mailing address

1431 N WESTERN AVE STE 202
CHICAGO IL
60622-7712
US

V. Phone/Fax

Practice location:
  • Phone: 773-489-6605
  • Fax: 312-633-5863
Mailing address:
  • Phone: 773-489-6605
  • Fax: 312-633-5863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number036049729
License Number StateIL

VIII. Authorized Official

Name: MRS. SARAH STRONG
Title or Position: BILLING MANAGER
Credential:
Phone: 630-802-7385