Healthcare Provider Details

I. General information

NPI: 1558429696
Provider Name (Legal Business Name): VIRGILIO M MAGSINO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5025 N PAULINA ST
CHICAGO IL
60640-2772
US

IV. Provider business mailing address

2640 QUAIL LN
NORTHBROOK IL
60062-7627
US

V. Phone/Fax

Practice location:
  • Phone: 773-271-9040
  • Fax: 708-535-7875
Mailing address:
  • Phone: 847-564-0202
  • Fax: 708-535-7875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036046234
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: