Individual
CARL VANCOL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
45 W 111TH ST, SUITE 304, CHICAGO, IL 60628-4200
(773) 995-3463
Mailing address
8646 S SAGINAW AVE, CHICAGO, IL 60617-2422
(773) 768-0811
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
036098516
IL
207QA0000X
Adolescent Medicine (Family Medicine) Physician
036098516
IL
207QA0505X
Adult Medicine Physician
Primary
036098516
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001633398
BLUE CROSS BLUE SHIELD
IL
05
—
036098516
—
IL
01
—
080193944
RAILROAD MEDICARE
IL
01
—
1625687
BCBS ILLINOIS
IL
Enumeration date
08/16/2005
Last updated
02/04/2026
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