Vallejo, Ricardo

Vallejo, Ricardo is an individual health care provider with primary practice located at 1015 S Mercer Ave , Bloomington IL 61701-7107. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Interventional Pain Medicine, Allopathic & Osteopathic Physicians / Pain Medicine. Allopathic & Osteopathic Physicians / Pain Medicine is his primary health care specialty. Vallejo, Ricardo can be contacted via phone (309) 662-4321.

Contact Information

Primary practice address
1015 S Mercer Ave Bloomington IL 61701-7107
Phone: (309) 662-4321
Fax: (309) 661-4532
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Interventional Pain Medicine 208VP0014X 036107002 Illinois
Allopathic & Osteopathic Physicians / Pain Medicine 207LP2900X 036107002 Illinois

Profile Details

NPI number 1669469706
LBN Legal business name Vallejo, Ricardo
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 4th, 2005
Last updated Mar 19th, 2020 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1669469706 NPPES
Illinois MEDICAID 036107002

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