Provider Demographics
NPI:1982630471
Name:URIBE, VICTOR M (MD SC)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:M
Last Name:URIBE
Suffix:
Gender:M
Credentials:MD SC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1672 E MISSION HILLS ROAD
Mailing Address - Street 2:
Mailing Address - City:NORTH BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062
Mailing Address - Country:US
Mailing Address - Phone:773-645-3449
Mailing Address - Fax:773-645-3453
Practice Address - Street 1:1431 N WESTERN AVENUE
Practice Address - Street 2:SUITE 504
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-1774
Practice Address - Country:US
Practice Address - Phone:773-645-3449
Practice Address - Fax:773-645-3453
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-25
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
C41328Medicare UPIN
IL211902Medicare PIN
ILK18515Medicare PIN