Provider Demographics
NPI:1245385699
Name:VARGAS, LEONARDO (MD)
Entity type:Individual
Prefix:
First Name:LEONARDO
Middle Name:
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 1:1500 WAUKEGAN RD
Mailing Address - Street 2:SUITE 221
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-2100
Mailing Address - Country:US
Mailing Address - Phone:847-998-0120
Mailing Address - Fax:847-998-0131
Practice Address - Street 1:1500 WAUKEGAN RD
Practice Address - Street 2:SUITE 221
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-2100
Practice Address - Country:US
Practice Address - Phone:847-998-0120
Practice Address - Fax:847-998-0131
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036098800207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH18894Medicare UPIN