Healthcare Provider Details

I. General information

NPI: 1780773994
Provider Name (Legal Business Name): DAVID VIGDER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 12/08/2020
Certification Date: 12/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 N WESTMORELAND RD SUITE 206
LAKE FOREST IL
60045-1673
US

IV. Provider business mailing address

800 N WESTMORELAND RD SUITE 206
LAKE FOREST IL
60045-1673
US

V. Phone/Fax

Practice location:
  • Phone: 847-615-2227
  • Fax: 847-615-2228
Mailing address:
  • Phone: 847-615-2227
  • Fax: 847-615-2228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036094188
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: