Healthcare Provider Details

I. General information

NPI: 1457309817
Provider Name (Legal Business Name): DUPAGE VALLEY ANESTHESIOLOGISTS, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 04/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 S WASHINGTON ST
NAPERVILLE IL
60540-7430
US

IV. Provider business mailing address

387 SHUMAN BLVD SUITE 240 W
NAPERVILLE IL
60563-8450
US

V. Phone/Fax

Practice location:
  • Phone: 630-355-0450
  • Fax:
Mailing address:
  • Phone: 630-868-2200
  • Fax: 630-868-2240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. FRANK M. GENTILE
Title or Position: PRESIDENT
Credential: MD
Phone: 630-868-2200