Healthcare Provider Details

I. General information

NPI: 1306342258
Provider Name (Legal Business Name): JUSTIN DEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2018
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 N WINFIELD RD
WINFIELD IL
60190-1379
US

IV. Provider business mailing address

819 N SUMMIT ST
WHEATON IL
60187-4453
US

V. Phone/Fax

Practice location:
  • Phone: 630-933-1600
  • Fax: 312-227-6090
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number036.171107
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: