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General NPI Number Information
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NPI Number | 1194832212
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Entity Type | Individual
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Provider Name | DR. VIJAY K MAKER
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Gender | Male
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Dates
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Enumeration Date | 08/24/2006
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Last Update Date | 08/17/2016
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Provider Practice Location Address
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Address Line | 3000 N HALSTED ST STE 500
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City | CHICAGO
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State | IL
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Zip | 60657-5194
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Country | US
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Telephone | 773-296-5346
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Fax | 773-296-5570
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Provider Business Mailing Address
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Address Line | 1055 HILLCREST RD
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City | GLENCOE
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State | IL
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Zip | 60022-1215
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Country | US
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Telephone | 773-296-5346
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Fax | 773-296-5570
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 036045277
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License Number State | IL
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