Provider Demographics
NPI:1710082615
Name:GUERRIERO, VITTORIO (MD)
Entity Type:Individual
Prefix:
First Name:VITTORIO
Middle Name:
Last Name:GUERRIERO
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 1:45 W 111TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628-4294
Mailing Address - Country:US
Mailing Address - Phone:773-995-3116
Mailing Address - Fax:773-637-2006
Practice Address - Street 1:45 W 111TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-4294
Practice Address - Country:US
Practice Address - Phone:773-995-3116
Practice Address - Fax:773-660-4505
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036058757208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036058757Medicaid
IL31600319OtherBLUE SHIELD OF IL
IL31600319OtherBLUE SHIELD OF IL
IL695760Medicare ID - Type Unspecified