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NPI Code Detail

MEDICARE: DR. GREGORY C. VACHON M.D.

MEDICARE: DR. GREGORY C. VACHON M.D.
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
1207R00000XInternal Medicine Physician036089597IL

General Provider Information

NPI Number : 1376577841
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GREGORY C. VACHON M.D.
Provider Business Mailing Address
First Line : 846 N OAK PARK AVE
Second Line :
City : OAK PARK
State : IL
Zip : 60302-1539
Country : US
Telephone Number : 708-763-9580
Fax Number :
Provider Business Practice Location Address
First Line : 4259 S BERKELEY AVE
Second Line : KOMED HEALTH CENTER
City : CHICAGO
State : IL
Zip : 60653-3030
Country : US
Telephone Number : 312-285-7678
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/10/2006
Last Update Date : 04/03/2012

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