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General NPI Number Information
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NPI Number | 1497910418
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Entity Type | Organization
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Legal Business Name | GERIATRIC CARE SPECIALISTS, LTD
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Dates
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Enumeration Date | 07/21/2008
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Last Update Date | 09/04/2008
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Provider Practice Location Address
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Address Line | 1700 ROBIN LN
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City | LISLE
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State | IL
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Zip | 60532-4155
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Country | US
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Telephone | 630-800-5646
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 900
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City | LA GRANGE
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State | IL
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Zip | 60525-0900
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Country | US
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Telephone | 630-800-5646
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JEROME DONNELLY
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Credential | DO
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Telephone | 630-800-5646
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | 036075925
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License Number State | IL
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