Provider Demographics
NPI:1033317086
Name:VEST HART, ALYSSA JEANNE (DO)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:JEANNE
Last Name:VEST HART
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:JEANEE
Other - Last Name:VEST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:711 W NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-1174
Mailing Address - Country:US
Mailing Address - Phone:312-337-1982
Mailing Address - Fax:
Practice Address - Street 1:711 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-1174
Practice Address - Country:US
Practice Address - Phone:312-337-1982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036123047207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine