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NPI Code Detail

MEDICARE: KARIN GUSTAFSON D.O.

MEDICARE: KARIN GUSTAFSON D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician036-083067IL

General Provider Information

NPI Number : 1336135573
Entity Type Code : Individual
Provider Name (Legal Business Name) : KARIN GUSTAFSON D.O.
Provider Business Mailing Address
First Line : 1256 WATERFORD DRIVE
Second Line : SUITE 230
City : AURORA
State : IL
Zip : 60504
Country : US
Telephone Number : 630-499-2404
Fax Number : 630-499-2399
Provider Business Practice Location Address
First Line : 2020 OGDEN AVE
Second Line : SUITE 120
City : AURORA
State : IL
Zip : 60504-5894
Country : US
Telephone Number : 630-375-2852
Fax Number : 630-375-2838
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/22/2005
Last Update Date : 07/07/2017

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Directions to “ KARIN GUSTAFSON D.O.” Practice Location

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