Provider Demographics
NPI:1467441550
Name:VIJIL, JULIO CESAR SR (MD)
Entity Type:Individual
Prefix:MR
First Name:JULIO
Middle Name:CESAR
Last Name:VIJIL
Suffix:SR
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:2901 OLD JACKSONVILLE RD
Mailing Address - Street 2:SUITE B3
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-7439
Mailing Address - Country:US
Mailing Address - Phone:217-698-8850
Mailing Address - Fax:217-698-8904
Practice Address - Street 1:2901 OLD JACKSONVILLE RD
Practice Address - Street 2:SUITE B3
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-7439
Practice Address - Country:US
Practice Address - Phone:217-698-8850
Practice Address - Fax:217-698-8904
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209547Medicare ID - Type Unspecified
D09929Medicare UPIN