=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841221058
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MIKHAIL VAGER MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/05/2006
-----------------------------------------------------
Last Update Date | 09/27/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12251 S 80TH AVE
-----------------------------------------------------
City | PALOS HEIGHTS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60463-1290
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-923-3936
-----------------------------------------------------
Fax | 708-923-8848
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12251 S 80TH AVE
-----------------------------------------------------
City | PALOS HEIGHTS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60463-1290
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-923-3936
-----------------------------------------------------
Fax | 708-923-8848
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | 036-104259
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------