Provider Demographics
NPI:1205855020
Name:VARGAS-MONTANO, JUAN F (MD)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:F
Last Name:VARGAS-MONTANO
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:PO BOX 798
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-0798
Mailing Address - Country:US
Mailing Address - Phone:847-692-6218
Mailing Address - Fax:847-692-5609
Practice Address - Street 1:1945 W WILSON AVE
Practice Address - Street 2:SUITE 2113
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-5255
Practice Address - Country:US
Practice Address - Phone:773-784-0851
Practice Address - Fax:773-769-3431
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-048889207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036048889Medicaid
L95892Medicare ID - Type Unspecified
IL036048889Medicaid