Individual
DR. GEORGE VERGHESE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
555 W COURT ST, SUITE 403, KANKAKEE, IL 60901-3664
(815) 802-8031
Mailing address
555 W COURT ST, SUITE 403, KANKAKEE, IL 60901-3664
(815) 802-8031
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
036101532
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036101532
—
IL
Enumeration date
03/08/2006
Last updated
10/01/2012
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