| Vivacious Group Inc. | |
|
8s165 S Vine St Burr Ridge IL 60527-5541 | |
| (630) 835-7613 | |
| Not Available |
| Full Name | Vivacious Group Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 8s165 S Vine St, Burr Ridge, Illinois |
| Authorized Official Name and Position | Anto Maliakkal (PRESIDENT) |
| Authorized Official Contact | 6308357613 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vivacious Group Inc. 8s165 S Vine St Burr Ridge IL 60527-5541 Ph: () - | Vivacious Group Inc. 8s165 S Vine St Burr Ridge IL 60527-5541 Ph: (630) 835-7613 |
| NPI Number | 1275702888 |
|---|---|
| Provider Enumeration Date | 02/27/2008 |
| Last Update Date | 05/31/2023 |
| Medicare PECOS PAC ID | 4486730611 |
|---|---|
| Medicare Enrollment ID | O20080327000544 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275702888 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (Illinois) | Primary |
| Provider Name | Anto V Maliakkal |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1558376368 PECOS PAC ID: 9739273699 Enrollment ID: I20080327000533 |
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