Healthcare Provider Details

I. General information

NPI: 1891770624
Provider Name (Legal Business Name): DENNIS S. ASENSIO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 12/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2765 MAPLE AVE
LISLE IL
60532-3280
US

IV. Provider business mailing address

2765 MAPLE AVE
LISLE IL
60532-3280
US

V. Phone/Fax

Practice location:
  • Phone: 630-579-9817
  • Fax: 630-579-9846
Mailing address:
  • Phone: 630-579-9817
  • Fax: 630-579-9846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036-075848
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: