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General NPI Number Information
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NPI Number | 1508220989
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Entity Type | Organization
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Legal Business Name | VISTA HEALTH SYSTEM
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Dates
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Enumeration Date | 04/11/2016
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Last Update Date | 04/11/2016
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Provider Practice Location Address
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Address Line | 2615 WASHINGTON ST
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City | WAUKEGAN
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State | IL
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Zip | 60085-4980
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Country | US
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Telephone | 847-360-2467
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Fax |
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Provider Business Mailing Address
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Address Line | 2018 ADAMS CT
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City | GURNEE
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State | IL
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Zip | 60031-6096
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Country | US
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Telephone | 847-502-8085
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. RICHARD MARGOLIN
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Credential | MD
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Telephone | 847-231-5300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1800X
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Taxonomy Name | Corporate Health Clinic/Center
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License Number | 209013996
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License Number State | IL
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