Individual
DR. HUMBERTO VERGARA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1431 N WESTERN AVE, SUITE 205, CHICAGO, IL 60622-1797
(773) 278-4811
(773) 278-5920
Mailing address
1431 N WESTERN AVE, SUITE 205, CHICAGO, IL 60622-1797
(773) 278-4811
(773) 278-5920
Taxonomy
Speciality
Code
Description
License number
State
207QA0401X
Addiction Medicine (Family Medicine) Physician
Primary
036-072013
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036072013
—
IL
Enumeration date
12/20/2005
Last updated
08/31/2010
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