Healthcare Provider Details

I. General information

NPI: 1083685572
Provider Name (Legal Business Name): DAVID A SUTTON P.A. - C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 09/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2940 ROLLINGRIDGE RD SUITE 201
NAPERVILLE IL
60564-4231
US

IV. Provider business mailing address

2940 ROLLINGRIDGE RD SUITE 201
NAPERVILLE IL
60564-4231
US

V. Phone/Fax

Practice location:
  • Phone: 630-967-6000
  • Fax: 630-428-3971
Mailing address:
  • Phone: 630-967-6000
  • Fax: 630-428-3971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085-001486
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: