Provider Demographics
NPI:1780773994
Name:VIGDER, DAVID (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:VIGDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 N WESTMORELAND RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-1673
Mailing Address - Country:US
Mailing Address - Phone:847-615-2227
Mailing Address - Fax:847-615-2228
Practice Address - Street 1:800 N WESTMORELAND RD
Practice Address - Street 2:SUITE 206
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-1673
Practice Address - Country:US
Practice Address - Phone:847-615-2227
Practice Address - Fax:847-615-2228
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036094188207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4922698OtherBLUE SHIELD BLUE CROSS
IL4922698OtherBLUE SHIELD BLUE CROSS
ILG87255Medicare UPIN
IL036094188Medicare ID - Type Unspecified