Provider Demographics
NPI:1295734895
Name:VARGAS, EDGAR J (MD)
Entity type:Individual
Prefix:
First Name:EDGAR
Middle Name:J
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 1:1260 W HIGGINS RD.
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60195-3033
Mailing Address - Country:US
Mailing Address - Phone:847-983-8356
Mailing Address - Fax:888-909-5815
Practice Address - Street 1:1260 W HIGGINS RD
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60195-3033
Practice Address - Country:US
Practice Address - Phone:847-983-8356
Practice Address - Fax:888-909-5815
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036047133207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL21621833OtherBLUECROSS AND BLUESHIELD
IL4211566OtherAETNA
IL0360471331Medicaid
ILL99337Medicare ID - Type Unspecified
IL0360471331Medicaid