Provider Demographics
NPI:1861663692
Name:FALGUNI VASA MD SC
Entity Type:Organization
Organization Name:FALGUNI VASA MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:FALGUNI
Authorized Official - Middle Name:R
Authorized Official - Last Name:VASA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-848-1332
Mailing Address - Street 1:720 BROM CT
Mailing Address - Street 2:SUITE 204
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-6531
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:720 BROM CT
Practice Address - Street 2:SUITE 204
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-6531
Practice Address - Country:US
Practice Address - Phone:630-848-1332
Practice Address - Fax:630-848-1344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2008-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036098874207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
209366Medicare PIN
ILH66006Medicare UPIN
IL1184741951Medicare PIN