Provider Demographics
NPI:1083698526
Name:VARGAS, AXEL (MD)
Entity Type:Individual
Prefix:DR
First Name:AXEL
Middle Name:
Last Name:VARGAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1049 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-1759
Mailing Address - Country:US
Mailing Address - Phone:312-961-6471
Mailing Address - Fax:888-961-6471
Practice Address - Street 1:1213 WILMETTE AVE
Practice Address - Street 2:SUITE # 2G
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-2566
Practice Address - Country:US
Practice Address - Phone:888-951-6471
Practice Address - Fax:888-961-6471
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-29
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036089572207LP2900X
IL36-089572208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G12598Medicare UPIN
ILL94321-203133Medicare PIN
IL201226Medicare PIN