Individual
DR. RICARDO VALLEJO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1015 S MERCER AVE, BLOOMINGTON, IL 61701-7107
(309) 662-4321
(309) 661-4532
Mailing address
1015 S MERCER AVE, BLOOMINGTON, IL 61701-7107
(309) 662-4321
(309) 661-4532
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
036107002
IL
208VP0014X
Interventional Pain Medicine Physician
036107002
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036107002
—
IL
Enumeration date
10/04/2005
Last updated
03/19/2020
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