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General NPI Number Information
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NPI Number | 1841485901
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Entity Type | Organization
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Legal Business Name | DOMINADOR L. DAYON JR., M.D.S.C.
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Dates
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Enumeration Date | 09/12/2007
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Last Update Date | 11/16/2007
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Provider Practice Location Address
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Address Line | 7906 S CRANDON AVE SUITE # 4
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City | CHICAGO
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State | IL
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Zip | 60617-1146
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Country | US
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Telephone | 773-768-5182
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Fax | 773-978-5930
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Provider Business Mailing Address
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Address Line | 11145 MARILYN CT
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City | ORLAND PARK
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State | IL
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Zip | 60467-7467
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Country | US
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Telephone | 708-307-3555
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Fax | 773-978-5930
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | DR. DOMINADOR L DAYON JR.
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Credential | M.D.
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Telephone | 708-307-3555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036052751
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License Number State | IL
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