Healthcare Provider Details

I. General information

NPI: 1447367479
Provider Name (Legal Business Name): DAVID H VANTHIEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 07/18/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3245 GROVE AVE
BERWYN IL
60402-3474
US

IV. Provider business mailing address

401 E ONTARIO ST 4005
CHICAGO IL
60611-3051
US

V. Phone/Fax

Practice location:
  • Phone: 414-236-7224
  • Fax: 708-290-1014
Mailing address:
  • Phone: 414-236-7224
  • Fax: 708-290-1014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number46537
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207RI0008X
TaxonomyHepatology Physician
License Number036096121
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number102216
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: