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1245222454

NPI Code Detail

MEDICARE: CARL VANCOL MD

MEDICARE: CARL VANCOL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	036098516	IL
2	207QA0505X	Adult Medicine Physician	036098516	IL
3	207QA0000X	Adolescent Medicine (Family Medicine) Physician	036098516	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	080193944	OTHER	IL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1625687	OTHER	IL	BCBS ILLINOIS
3	0001633398	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1245222454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARL VANCOL MD

Provider Business Mailing Address
First Line	:	8646 S SAGINAW AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60617-2422
Country	:	US
Telephone Number	:	773-768-0811
Fax Number	:

Provider Business Practice Location Address
First Line	:	45 W 111TH ST
Second Line	:	SUITE 304
City	:	CHICAGO
State	:	IL
Zip	:	60628-4200
Country	:	US
Telephone Number	:	773-995-3463
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	02/04/2026

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Directions to “ CARL VANCOL MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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