Healthcare Provider Details

I. General information

NPI: 1447438064
Provider Name (Legal Business Name): DOMINIQUE BAZILE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2008
Last Update Date: 02/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N HIGHLAND AVE
AURORA IL
60506-1401
US

IV. Provider business mailing address

1200 N HIGHLAND AVE
AURORA IL
60506-1401
US

V. Phone/Fax

Practice location:
  • Phone: 630-892-7055
  • Fax: 630-892-4590
Mailing address:
  • Phone: 630-892-7055
  • Fax: 630-892-4590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZB0001X
TaxonomyBlood Banking & Transfusion Medicine Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: