Provider Demographics
NPI:1093914558
Name:VIGIL, CARLOS ENRIQUE (MD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:ENRIQUE
Last Name:VIGIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CARLOS
Other - Middle Name:ENRIQUE
Other - Last Name:VIGIL GONZALES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LEGAL
Mailing Address - Street 1:676 N SAINT CLAIR ST STE 850
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3124
Mailing Address - Country:US
Mailing Address - Phone:312-695-6180
Mailing Address - Fax:312-695-6189
Practice Address - Street 1:676 N SAINT CLAIR ST STE 850
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3124
Practice Address - Country:US
Practice Address - Phone:312-695-6180
Practice Address - Fax:312-695-6189
Is Sole Proprietor?:No
Enumeration Date:2007-07-15
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003658207RH0003X
IAMD-42737207RH0003X
IL036155026207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03258546Medicaid
NY03258546Medicaid