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General NPI Number Information
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NPI Number | 1275731671
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Entity Type | Organization
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Legal Business Name | GEORGE B VERGHESE MD SC
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Dates
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Enumeration Date | 07/06/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 555 W COURT ST
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City | KANKAKEE
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State | IL
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Zip | 60901-3664
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Country | US
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Telephone | 815-802-8031
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Fax | 815-802-8044
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Provider Business Mailing Address
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Address Line | PO BOX 787
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City | KANKAKEE
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State | IL
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Zip | 60901-0787
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Country | US
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Telephone | 815-802-8031
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GEORGE B VERGHESE
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Credential | MD
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Telephone | 815-802-8031
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State | IL
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