Healthcare Provider Details

I. General information

NPI: 1457465866
Provider Name (Legal Business Name): G. SPITZ, M.D., LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 04/02/2024
Certification Date: 04/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1256 WATERFORD DR SUITE 130
AURORA IL
60504-4510
US

IV. Provider business mailing address

1256 WATERFORD DR SUITE 130
AURORA IL
60504-4510
US

V. Phone/Fax

Practice location:
  • Phone: 630-820-2727
  • Fax: 630-820-7427
Mailing address:
  • Phone: 630-820-2727
  • Fax: 630-820-7427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: LORNELL E HANSEN II
Title or Position: OWNER
Credential: MD
Phone: 605-274-0217