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General NPI Number Information
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NPI Number | 1629774898
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Entity Type | Organization
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Legal Business Name | DR. ROBERT A. GENDREAU, PLLC
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Dates
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Enumeration Date | 01/31/2023
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Last Update Date | 01/31/2023
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Provider Practice Location Address
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Address Line | 2 E 22ND ST STE 305
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City | LOMBARD
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State | IL
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Zip | 60148-6125
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Country | US
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Telephone | 331-285-8341
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Fax |
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Provider Business Mailing Address
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Address Line | 1113 LODGEPOLE CT
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City | DARIEN
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State | IL
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Zip | 60561-3890
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Country | US
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Telephone | 415-515-9734
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBERT A. GENDREAU
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Credential |
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Telephone | 331-285-8341
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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