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General NPI Number Information
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NPI Number | 1154361921
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Entity Type | Organization
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Legal Business Name | DAVID G VERMILLION M D P C
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Dates
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Enumeration Date | 06/08/2006
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Last Update Date | 12/18/2017
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Provider Practice Location Address
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Address Line | 1802 N DIVISION ST STE 201
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City | MORRIS
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State | IL
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Zip | 60450-1183
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Country | US
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Telephone | 815-513-5625
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Fax | 815-513-5624
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Provider Business Mailing Address
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Address Line | 1802 N DIVISION ST STE 201
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City | MORRIS
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State | IL
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Zip | 60450-1183
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Country | US
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Telephone | 815-513-5625
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Fax | 815-513-5624
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Authorized Official
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Title or Position | BILLER/CODER
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Name | MARY M. SMITH
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Credential |
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Telephone | 815-942-5200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 208000000X
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 207R00000X
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License Number State | IL
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