Provider Demographics
NPI:1194785691
Name:VASQUEZ, RICHARD E (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:E
Last Name:VASQUEZ
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 1:39182 TREASURY CTR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60694-9000
Mailing Address - Country:US
Mailing Address - Phone:630-734-0200
Mailing Address - Fax:
Practice Address - Street 1:3424 CURACAO CT
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-8141
Practice Address - Country:US
Practice Address - Phone:312-925-4241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036091114207PE0004X
FLMD125904207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036091114Medicaid
ILL61214Medicare ID - Type Unspecified