=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255388807
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ILLINOIS MEDICAL DOCTORS OF NAPERVILLE ENTERPRISING SC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/28/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1891 BAY SCOTT CIR STE 109
-----------------------------------------------------
City | NAPERVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60540-1137
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-527-6400
-----------------------------------------------------
Fax | 630-527-6411
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1891 BAY SCOTT CIR STE 109
-----------------------------------------------------
City | NAPERVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60540-1137
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-527-6400
-----------------------------------------------------
Fax | 630-527-6411
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. MATTHEW S CARDUCCI
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 630-527-6400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------