=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225150055
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ELADIO A VARGAS MD S C
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/04/2007
-----------------------------------------------------
Last Update Date | 06/17/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1500 WAUKEGAN ROAD #221
-----------------------------------------------------
City | GLENVIEW
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60025-2165
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-998-0120
-----------------------------------------------------
Fax | 847-998-0131
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1500 WAUKEGAN ROAD #221
-----------------------------------------------------
City | GLENVIEW
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60025-2165
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-998-0120
-----------------------------------------------------
Fax | 847-998-0131
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MD
-----------------------------------------------------
Name | ELADIO A VARGAS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 847-998-0120
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 036051813
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------