Healthcare Provider Details

I. General information

NPI: 1689048670
Provider Name (Legal Business Name): DREYER CLINIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2015
Last Update Date: 08/30/2021
Certification Date: 08/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24508 W VILLAGE CTR DR
PLAINFIELD IL
60544-1885
US

IV. Provider business mailing address

2357 SEQUOIA DR
AURORA IL
60506-6222
US

V. Phone/Fax

Practice location:
  • Phone: 815-439-9400
  • Fax:
Mailing address:
  • Phone: 630-859-6800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: NAN NELSON
Title or Position: EVP FINANCIAL OPS
Credential:
Phone: 414-299-1610