Provider Demographics
NPI:1467540567
Name:VARGAS-ZAPATA, RAFAEL J (MD)
Entity Type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:J
Last Name:VARGAS-ZAPATA
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 1:10627 S PULASKI RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60655-3827
Mailing Address - Country:US
Mailing Address - Phone:773-779-9300
Mailing Address - Fax:773-779-5768
Practice Address - Street 1:10627 S PULASKI RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60655-3827
Practice Address - Country:US
Practice Address - Phone:773-779-9300
Practice Address - Fax:773-779-5768
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2009-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036072512207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036072512Medicaid
ILL77296Medicare PIN
IL036072512Medicaid