Healthcare Provider Details

I. General information

NPI: 1508850405
Provider Name (Legal Business Name): GREGORIO L CARPIO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 04/08/2020
Certification Date: 04/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 OGDEN AVE SUITE 225
AURORA IL
60504-5894
US

IV. Provider business mailing address

2020 OGDEN AVE STE 225
AURORA IL
60504-6193
US

V. Phone/Fax

Practice location:
  • Phone: 630-978-4800
  • Fax: 630-978-6791
Mailing address:
  • Phone: 630-978-4800
  • Fax: 630-978-6791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036082108
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: