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NPI Code Detail

MEDICARE: DR. DONALD M DEDONATO M.D.

MEDICARE:  DR. DONALD M DEDONATO  M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207V00000XObstetrics & Gynecology PhysicianIL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2CA5143OTHERILMEDICARE RAILROAD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
131602433OTHERILBCBS PROVIDER NUMBER

General Provider Information

NPI Number : 1114925450
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DONALD M DEDONATO M.D.
Provider Business Mailing Address
First Line : 1630 W CENTRAL RD
Second Line :
City : ARLINGTON HTS
State : IL
Zip : 60005-2407
Country : US
Telephone Number : 847-394-3553
Fax Number : 847-394-3574
Provider Business Practice Location Address
First Line : 1630 W CENTRAL RD
Second Line :
City : ARLINGTON HTS
State : IL
Zip : 60005-2407
Country : US
Telephone Number : 847-394-3553
Fax Number : 847-394-3574
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2005
Last Update Date : 12/28/2007

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Directions to “ DR. DONALD M DEDONATO M.D.” Practice Location

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