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NPI Code Detail

MEDICARE: DOWNERS GROVE GERIATRICS, LLC

MEDICARE: DOWNERS GROVE GERIATRICS, LLC
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
1207RG0300XGeriatric Medicine (Internal Medicine) Physician036106287IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11124078365OTHERINDIVIDUAL NPI FOR RACHEL MAYORGA MD

General Provider Information

NPI Number : 1326209446
Entity Type Code : Organization
Provider Name (Legal Business Name) : DOWNERS GROVE GERIATRICS, LLC
Provider Business Mailing Address
First Line : 4411 ROSLYN RD
Second Line :
City : DOWNERS GROVE
State : IL
Zip : 60515-5804
Country : US
Telephone Number : 630-241-3779
Fax Number : 630-241-9309
Provider Business Practice Location Address
First Line : 3800 HIGHLAND AVE STE 111
Second Line :
City : DOWNERS GROVE
State : IL
Zip : 60515-1558
Country : US
Telephone Number : 630-241-3779
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DR. RACHEL ALIMA MAYORGA
Credential : M.D.
Telephone Number : 630-241-3779
Provider Enumeration Date : 06/20/2008
Last Update Date : 08/26/2008

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Directions to “DOWNERS GROVE GERIATRICS, LLC ” Practice Location

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