Provider Demographics
NPI:1164263133
Name:BVGMEDICAL PLLC
Entity type:Organization
Organization Name:BVGMEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERON CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-618-2378
Mailing Address - Street 1:566 LINCOLN AVE UNIT 2E
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:IL
Mailing Address - Zip Code:60093-2354
Mailing Address - Country:US
Mailing Address - Phone:847-226-5503
Mailing Address - Fax:
Practice Address - Street 1:3400 DUNDEE RD STE 230
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2334
Practice Address - Country:US
Practice Address - Phone:847-226-5503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-04
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty