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General NPI Number Information
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NPI Number | 1144214644
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Entity Type | Organization
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Legal Business Name | VISTA FAMILY MEDICINE INC
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Dates
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Enumeration Date | 09/12/2005
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Last Update Date | 04/01/2008
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Provider Practice Location Address
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Address Line | 10961 S KEDZIE AVE
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City | CHICAGO
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State | IL
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Zip | 60655-2219
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Country | US
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Telephone | 773-239-9100
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Fax | 773-239-9102
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Provider Business Mailing Address
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Address Line | 10961 S KEDZIE AVE
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City | CHICAGO
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State | IL
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Zip | 60655-2219
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Country | US
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Telephone | 773-239-9100
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Fax | 773-239-9102
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAMES PAUL VALEK
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Credential | M.D.
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Telephone | 773-239-9100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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