Healthcare Provider Details

I. General information

NPI: 1902364508
Provider Name (Legal Business Name): EDUARDO VACA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2019
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 W TEMPLE AVE STE 2500
EFFINGHAM IL
62401-2121
US

IV. Provider business mailing address

900 W TEMPLE AVE STE 2500
EFFINGHAM IL
62401-2121
US

V. Phone/Fax

Practice location:
  • Phone: 217-540-2350
  • Fax: 217-347-2323
Mailing address:
  • Phone: 217-540-2350
  • Fax: 217-347-2323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4301511546
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036177274
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: