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General NPI Number Information
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NPI Number | 1124053269
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Entity Type | Individual
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Provider Name | JENNIFER VARGAS MD
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Gender | Female
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 10/04/2018
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Provider Practice Location Address
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Address Line | 6447 CERMAK RD
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City | BERWYN
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State | IL
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Zip | 60402
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Country | US
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Telephone | 773-254-1400
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Fax |
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Provider Business Mailing Address
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Address Line | 966 W 21ST ST
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City | CHICAGO
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State | IL
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Zip | 60608-4511
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Country | US
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Telephone | 773-254-1400
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VX0000X
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Taxonomy Name | Obstetrics Physician
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License Number | 036113015
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036-113015
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License Number State | IL
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