Healthcare Provider Details

I. General information

NPI: 1841105608
Provider Name (Legal Business Name): CEPAMERICA ILLINOIS LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 W 95TH ST
EVERGREEN PARK IL
60805-2701
US

IV. Provider business mailing address

1601 CUMMINS DR STE D
MODESTO CA
95358-6411
US

V. Phone/Fax

Practice location:
  • Phone: 708-422-6200
  • Fax:
Mailing address:
  • Phone: 510-851-7501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID BIRDSALL
Title or Position: ADMINISTRATIVE VP OF OPERATIONS
Credential: MD
Phone: 510-350-2600