Healthcare Provider Details
I. General information
NPI: 1336938232
Provider Name (Legal Business Name): USP CLINICAL GPS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 05/06/2025
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:
III. Provider practice location address
638 N INDEPENDENCE BLVD
ROMEOVILLE IL
60446-1374
US
IV. Provider business mailing address
638 N INDEPENDENCE BLVD
ROMEOVILLE IL
60446-1374
US
V. Phone/Fax
- Phone: 815-886-0875
- Fax:
- Phone:
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 1223G0001X |
| Taxonomy | General Practice Dentistry |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
WILLIAM
LITTLE
Title or Position: OWNER
Credential:
Phone: 815-886-0875