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General NPI Number Information
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NPI Number | 1740492875
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Entity Type | Organization
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Legal Business Name | RIJ L VIRASCH MD
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2800 N SHERIDAN RD.
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City | CHICAGO
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State | IL
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Zip | 60657
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Country | US
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Telephone | 773-935-5500
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Fax |
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Provider Business Mailing Address
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Address Line | 9349 NEENAH AVENUE
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City | MORTON GROVE
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State | IL
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Zip | 60053
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Country | US
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Telephone | 630-424-1122
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Fax |
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | TAMMY SANCHEZ
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Credential |
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Telephone | 630-424-1122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State | IL
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