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General NPI Number Information
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NPI Number | 1790779692
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Entity Type | Individual
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Provider Name | DONALD ROBERT WAXLER MD
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Gender | Male
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Dates
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Enumeration Date | 09/07/2005
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Last Update Date | 09/27/2012
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Provider Practice Location Address
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Address Line | 450 W HWY 22
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City | BARRINGTON
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State | IL
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Zip | 60010
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Country | US
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Telephone | 847-842-4191
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Fax | 847-842-4107
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Provider Business Mailing Address
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Address Line | 438 W COUNTY LINE RD
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City | BARRINGTON
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State | IL
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Zip | 60010
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Country | US
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Telephone | 847-382-2739
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Fax | 847-842-4107
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | ME52005
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 036057216
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License Number State | IL
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