Provider Demographics
NPI:1528098365
Name:VAIKUTIS, JOHN P (DO)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:VAIKUTIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 BEVERLY DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60502-8516
Mailing Address - Country:US
Mailing Address - Phone:630-315-8700
Mailing Address - Fax:630-315-8777
Practice Address - Street 1:2800 BEVERLY DR
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60502-8516
Practice Address - Country:US
Practice Address - Phone:630-315-8700
Practice Address - Fax:630-315-8777
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036084166207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL3631498336019001OtherCDPG HFS PAYEE ID
IL482450OtherMEDICARE GROUP NUMBER
IL0222075OtherBLUE CROSS GROUP NUMBER
IL036084166Medicaid
IL363149833OtherTAX IDENTIFICATION NUMBER
IL3631498336019001OtherCDPG HFS PAYEE ID
IL482450OtherMEDICARE GROUP NUMBER