Healthcare Provider Details

I. General information

NPI: 1538556774
Provider Name (Legal Business Name): JOSEPH GREGORY DADABO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2015
Last Update Date: 07/20/2020
Certification Date: 07/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2180 PFINGSTEN RD STE 2000
GLENVIEW IL
60026-1339
US

IV. Provider business mailing address

2180 PFINGSTEN RD STE 2000
GLENVIEW IL
60026-1339
US

V. Phone/Fax

Practice location:
  • Phone: 847-503-4500
  • Fax: 847-657-5754
Mailing address:
  • Phone: 847-503-4500
  • Fax: 847-657-5754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number036.151658
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number036151658
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: