Healthcare Provider Details

I. General information

NPI: 1710428065
Provider Name (Legal Business Name): VINCENT CHARLES SPEARS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2017
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2530 RIDGE AVE
EVANSTON IL
60201-2492
US

IV. Provider business mailing address

2530 RIDGE AVE
EVANSTON IL
60201-2492
US

V. Phone/Fax

Practice location:
  • Phone: 847-869-0892
  • Fax: 847-869-1070
Mailing address:
  • Phone: 847-309-7072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036152075
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: