Healthcare Provider Details

I. General information

NPI: 1336136498
Provider Name (Legal Business Name): DANIEL OELSLAGER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 09/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

841 ARBOR AVE
WEST CHICAGO IL
60185-2092
US

IV. Provider business mailing address

841 ARBOR AVE
WEST CHICAGO IL
60185-2092
US

V. Phone/Fax

Practice location:
  • Phone: 630-715-2066
  • Fax:
Mailing address:
  • Phone: 630-715-2066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number085-000771
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: