Healthcare Provider Details

I. General information

NPI: 1164263133
Provider Name (Legal Business Name): BVGMEDICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2024
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 DUNDEE RD STE 230
NORTHBROOK IL
60062-2334
US

IV. Provider business mailing address

566 LINCOLN AVE UNIT 2E
WINNETKA IL
60093-2354
US

V. Phone/Fax

Practice location:
  • Phone: 847-226-5503
  • Fax:
Mailing address:
  • Phone: 847-226-5503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HELEN RIVERON CRUZ
Title or Position: PRACTICE MANAGER
Credential:
Phone: 773-618-2378