Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 036-113015 | IL |
N | 207VX0000X | Obstetrician | 036113015 | IL |
NPI | 1124053269 |
---|---|
Provider Name | Jennifer Vargas |
First Address | Chicago, IL 60608-4511 |
Second Address | Berwyn, IL 60402 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 04/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036113015 | (05) | IL |
I37900 | (02) |