Provider Demographics
NPI:1942481445
Name:JULIO C. VIJIL, SR., M.D.
Entity Type:Organization
Organization Name:JULIO C. VIJIL, SR., M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:F
Authorized Official - Last Name:MCCARREL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-698-8850
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:62704-7437
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:62704-7437
Practice Address - Country:US
Practice Address - Phone:217-698-8850
Practice Address - Fax:217-698-8904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-26
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1467441550OtherNPI
ILK08594Medicare PIN
ILD09929Medicare UPIN