Individual
JOHN P VAIKUTIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2800 BEVERLY DR, AURORA, IL 60502-8516
(630) 315-8700
(630) 315-8777
Mailing address
2800 BEVERLY DR, AURORA, IL 60502-8516
(630) 315-8700
(630) 315-8777
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036084166
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0222075
BLUE CROSS GROUP NUMBER
IL
05
—
036084166
—
IL
01
—
363149833
TAX IDENTIFICATION NUMBER
IL
01
—
3631498336019001
CDPG HFS PAYEE ID
IL
01
—
482450
MEDICARE GROUP NUMBER
IL
Enumeration date
07/04/2006
Last updated
03/23/2012
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