Provider Demographics
NPI:1699085381
Name:VALLEJO, DAVID JR (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:VALLEJO
Suffix:JR
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 1:13000 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:BLUE ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60406-2318
Mailing Address - Country:US
Mailing Address - Phone:708-385-6100
Mailing Address - Fax:708-385-2051
Practice Address - Street 1:13000 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:BLUE ISLAND
Practice Address - State:IL
Practice Address - Zip Code:60406-2318
Practice Address - Country:US
Practice Address - Phone:708-385-6100
Practice Address - Fax:708-385-2051
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-14
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.055159207V00000X
IL036.130292207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics