Healthcare Provider Details

I. General information

NPI: 1013915248
Provider Name (Legal Business Name): PATRICK J CAMODECA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 10/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10350 HALIGUS RD
HUNTLEY IL
60142
US

IV. Provider business mailing address

10350 HALIGUS RD
HUNTLEY IL
60142-9545
US

V. Phone/Fax

Practice location:
  • Phone: 815-338-6600
  • Fax: 847-802-7112
Mailing address:
  • Phone: 815-338-6600
  • Fax: 847-802-7112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036080930
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036080930
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: