Healthcare Provider Details

I. General information

NPI: 1356074173
Provider Name (Legal Business Name): VIP 2U, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2022
Last Update Date: 02/21/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W MARTIN LUTHER KING BLVD STE 1000
CHATTANOOGA TN
37402-2571
US

IV. Provider business mailing address

360 W BUTTERFIELD RD STE 325
ELMHURST IL
60126-5088
US

V. Phone/Fax

Practice location:
  • Phone: 423-521-5404
  • Fax: 423-425-9939
Mailing address:
  • Phone: 312-728-4728
  • Fax: 312-728-4729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER ZAMORA
Title or Position: MANAGER
Credential:
Phone: 312-728-4728