Individual
PHILIP MICHAEL VAZQUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1725 W HARRISON ST STE 970, CHICAGO, IL 60612-3828
(312) 942-7100
Mailing address
1725 W HARRISON ST STE 970, CHICAGO, IL 60612-3828
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
—
—
207L00000X
Anesthesiology Physician
Primary
125.081201
IL
208D00000X
General Practice Physician
2021-02554
NC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/28/2020
Last updated
05/31/2023
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