Healthcare Provider Details

I. General information

NPI: 1710082615
Provider Name (Legal Business Name): VITTORIO GUERRIERO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 04/05/2023
Certification Date: 04/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 W 111TH ST
CHICAGO IL
60628-4294
US

IV. Provider business mailing address

45 W 111TH ST
CHICAGO IL
60628-4294
US

V. Phone/Fax

Practice location:
  • Phone: 773-995-3116
  • Fax: 773-660-4505
Mailing address:
  • Phone: 773-995-3116
  • Fax: 773-637-2006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036058757
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: