Individual
MICHAEL GARY VICTOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
934 CENTER ST, ELGIN, IL 60120-2125
(630) 321-8300
(630) 321-8750
Mailing address
150 QUAIL RIDGE DR, WESTMONT, IL 60559-6142
(630) 321-8300
(630) 321-8750
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04532206
BLUE CROSS BLUE SHIELD
IL
Enumeration date
06/08/2006
Last updated
02/21/2008
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