Healthcare Provider Details

I. General information

NPI: 1497995872
Provider Name (Legal Business Name): ANTHONY M AURIEMMA MD SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2009
Last Update Date: 04/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 QUAIL RIDGE DR
WESTMONT IL
60559-6145
US

IV. Provider business mailing address

460 QUAIL RIDGE DR
WESTMONT IL
60559-6145
US

V. Phone/Fax

Practice location:
  • Phone: 630-887-2900
  • Fax:
Mailing address:
  • Phone: 630-887-2900
  • Fax: 630-986-2440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number042618962
License Number StateIL

VIII. Authorized Official

Name: ANTHONY AURIEMMA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 630-887-2900