MEDICARE: DR. AGUSTIN DEQUINA DORMITORIO 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
1	208600000X	Surgery Physician		IL

General Provider Information

NPI Number	:	1326120999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AGUSTIN DEQUINA DORMITORIO M.D.

Provider Business Mailing Address
First Line	:	1109 HYDE PARK LN
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60565-1622
Country	:	US
Telephone Number	:	773-578-1464
Fax Number	:

Provider Business Practice Location Address
First Line	:	5025 N PAULINA ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-2772
Country	:	US
Telephone Number	:	773-271-9040
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	06/14/2026

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