=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992934673
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REMEGIO M VILBAR MDSC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/02/2009
-----------------------------------------------------
Last Update Date | 07/02/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1431 N WESTERN AVE STE 202
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60622-7712
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-489-6605
-----------------------------------------------------
Fax | 312-633-5863
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1431 N WESTERN AVE STE 202
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60622-7712
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-489-6605
-----------------------------------------------------
Fax | 312-633-5863
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING MANAGER
-----------------------------------------------------
Name | MRS. SARAH STRONG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 630-802-7385
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 173000000X
-----------------------------------------------------
Taxonomy Name | Legal Medicine
-----------------------------------------------------
License Number | 036049729
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------