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Hans Willy Mautong Vasquez

Internal Medicine

Allopathic & Osteopathic Physicians

1901 W Harrison, Chicago, IL 60612-3714

PECOS Enrollment

This provider is enrolled in PECOS as HANS MAUTONG VASQUEZ.

Based on the most recent information from CMS, provider Hans Willy Mautong Vasquez is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1013750348
Provider Type
Individual
Full Name
Mautong Vasquez, Hans Willy
Credential
M.D

Gender
Male
Sole Proprietor
No
Enumeration Date
6/14/2024
Last Updated
4/21/2025

Contact Information

Practice Location

1901 W Harrison, Chicago, IL 60612-3714

(312) 864-6000

(484) 218-4916

Mailing Location

1901 W Harrison, Chicago, IL 60612-3714

(312) 864-6000

(312) 864-9725

Provider Taxonomies

Code	Description	License
Code 207R00000X Primary	Description Internal Medicine Allopathic & Osteopathic Physicians	License 125083903 Illinois
Code 390200000X	Description Student in an Organized Health Care Education/Training Program Student, Health Care	License Unlisted Issuer

Hans Willy Mautong Vasquez

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Ahmed, Aziz Uddin

Shilbayeh, Abdul-Rahim Ziyad Abdul-Rahim

Stobierska, Dorota

Gianarakis, Michael Nicholas

Kannayiram, Sandhya Shri

Putta, Aakash

Nanda, Kshitij

Xu, Rong

Yong, Sylvia Seokhee

Gudetta, Aron Berhanu