MEDICARE: VICTOR RAFAEL PLASENCIA 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	208000000X	Pediatrics Physician	03112680	IL

General Provider Information

NPI Number	:	1801077094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTOR RAFAEL PLASENCIA M.D.

Provider Business Mailing Address
First Line	:	5939 W DIVERSEY AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60639-1155
Country	:	US
Telephone Number	:	773-637-1600
Fax Number	:	773-637-1520

Provider Business Practice Location Address
First Line	:	5939 W DIVERSEY AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60639-1155
Country	:	US
Telephone Number	:	773-637-1600
Fax Number	:	773-637-2733

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

Provider Enumeration Date	:	11/16/2007
Last Update Date	:	06/18/2025

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