Healthcare Provider Details

I. General information

NPI: 1164480505
Provider Name (Legal Business Name): ROBERT DEAN VACEK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 07/19/2021
Certification Date: 07/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26W171 ROOSEVELT RD STE 101
WHEATON IL
60187-6002
US

IV. Provider business mailing address

26W171 ROOSEVELT RD STE 101
WHEATON IL
60187-6002
US

V. Phone/Fax

Practice location:
  • Phone: 630-933-4700
  • Fax: 630-933-4427
Mailing address:
  • Phone: 630-933-4700
  • Fax: 630-933-4427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036061168
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number036061168
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036061168
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: