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General NPI Number Information
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NPI Number | 1215066113
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Entity Type | Individual
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Provider Name | NICK A VLACHOS M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 18 SMOKEY CT
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City | BLOOMINGTON
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State | IL
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Zip | 61704-2706
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Country | US
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Telephone | 309-661-1000
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Fax | 309-661-1001
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Provider Business Mailing Address
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Address Line | PEKIN HOSPITAL 600 S. 13TH STREET, SUITE K
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City | PEKIN
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State | IL
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Zip | 61554-1109
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Country | US
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Telephone | 309-661-1000
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Fax | 309-661-1001
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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 | 2083P0500X
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Taxonomy Name | Preventive Medicine/Occupational Environmental Medicine Physician
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License Number |
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License Number State | IL
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