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General NPI Number Information
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NPI Number | 1154376234
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Entity Type | Organization
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Legal Business Name | DACIA MEDICAL PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 05/24/2006
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Last Update Date | 10/11/2011
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Provider Practice Location Address
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Address Line | 917 S OAK PARK AVE SUITE B
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City | OAK PARK
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State | IL
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Zip | 60304-1950
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Country | US
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Telephone | 708-358-1299
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Fax | 708-358-1418
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Provider Business Mailing Address
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Address Line | 917 S OAK PARK AVE SUITE B
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City | OAK PARK
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State | IL
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Zip | 60304-1950
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Country | US
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Telephone | 708-358-1299
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Fax | 708-358-1418
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MRS. CATALINA ANCA GRIJA
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Credential | M.D.
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Telephone | 708-358-1299
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 036096835
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License Number State | IL
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