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General NPI Number Information
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NPI Number | 1376577841
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Entity Type | Individual
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Provider Name | GREGORY C. VACHON M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 04/03/2012
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Provider Practice Location Address
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Address Line | 4259 S BERKELEY AVE KOMED HEALTH CENTER
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City | CHICAGO
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State | IL
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Zip | 60653-3030
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Country | US
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Telephone | 312-285-7678
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Fax |
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Provider Business Mailing Address
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Address Line | 846 N OAK PARK AVE
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City | OAK PARK
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State | IL
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Zip | 60302-1539
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Country | US
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Telephone | 708-763-9580
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Fax |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036089597
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License Number State | IL
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