Basic Information
| Provider Information | |||||||||
| NPI: | 1245542117 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VANDIVER | ||||||||
| FirstName: | CLAUDIA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2424 S PULASKI RD | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606233718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7732578347 | ||||||||
| FaxNumber: | 7732578400 | ||||||||
| Practice Location | |||||||||
| Address1: | 1044 N MOZART ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606223644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7732928300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2010 | ||||||||
| LastUpdateDate: | 12/27/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/27/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 125.058872 | IL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.