Provider Demographics
NPI:1639390388
Name:VARGAS, OMAR ARTURO (MD)
Entity Type:Individual
Prefix:DR
First Name:OMAR
Middle Name:ARTURO
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:PO BOX 19636
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62794-9636
Mailing Address - Country:US
Mailing Address - Phone:217-545-0182
Mailing Address - Fax:217-545-4735
Practice Address - Street 1:751 N RUTLEDGE ST
Practice Address - Street 2:SUITE 1100
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-4968
Practice Address - Country:US
Practice Address - Phone:217-545-0182
Practice Address - Fax:217-545-4735
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036117775207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036117775Medicaid
IL256510069Medicare PIN