MEDICARE: DR. VINCENT BOLISAY VARGAS 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
1	207Q00000X	Family Medicine Physician	036151210	IL
2	207Q00000X	Family Medicine Physician	MD443170	PA

General Provider Information

NPI Number	:	1629234851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VINCENT BOLISAY VARGAS M.D.

Provider Business Mailing Address
First Line	:	1131 W ADDISON ST APT 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-7064
Country	:	US
Telephone Number	:	773-296-2400
Fax Number	:	888-720-4714

Provider Business Practice Location Address
First Line	:	2835 N SHEFFIELD AVE STE 500
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-5084
Country	:	US
Telephone Number	:	773-296-2400
Fax Number	:	888-720-4714

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

Provider Enumeration Date	:	08/07/2008
Last Update Date	:	02/09/2026

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