Healthcare Provider Details

I. General information

NPI: 1760495774
Provider Name (Legal Business Name): DAVID M GARAGIOLA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 09/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11800 SOUTHWEST HWY
PALOS HEIGHTS IL
60463-1029
US

IV. Provider business mailing address

14 TODOR CT
BURR RIDGE IL
60527-8390
US

V. Phone/Fax

Practice location:
  • Phone: 708-361-0220
  • Fax: 708-923-3611
Mailing address:
  • Phone: 630-654-0693
  • Fax: 708-923-3611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: