Healthcare Provider Details

I. General information

NPI: 1851898167
Provider Name (Legal Business Name): ASSIST ONE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2018
Last Update Date: 05/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2426 OLD TAVERN RD
LISLE IL
60532-3623
US

IV. Provider business mailing address

2426 OLD TAVERN RD
LISLE IL
60532-3623
US

V. Phone/Fax

Practice location:
  • Phone: 708-705-3772
  • Fax:
Mailing address:
  • Phone: 708-705-3772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number238-000536
License Number StateIL

VIII. Authorized Official

Name: JAMES EDWARD GONZALES
Title or Position: OWNER
Credential: CSFA
Phone: 708-705-3772