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NPI Code Detail

MEDICARE: DIVERSFIED EMERGENCY SERVICES, LLC

MEDICARE: DIVERSFIED EMERGENCY SERVICES, 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
1207P00000XEmergency Medicine PhysicianIL

General Provider Information

NPI Number : 1770535098
Entity Type Code : Organization
Provider Name (Legal Business Name) : DIVERSFIED EMERGENCY SERVICES, LLC
Provider Business Mailing Address
First Line : PO BOX 5940
Second Line :
City : CAROL STREAM
State : IL
Zip : 60197-5940
Country : US
Telephone Number : 630-734-0200
Fax Number :
Provider Business Practice Location Address
First Line : 1431 N CLAREMONT AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60622-1702
Country : US
Telephone Number : 773-278-2000
Fax Number : 630-734-1560
Authorized Official
Title or Position : PRESIDENT
Name : SCOTT J. BETZELOS
Credential :
Telephone Number : 630-734-0200
Provider Enumeration Date : 05/16/2006
Last Update Date : 07/16/2007

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Directions to “DIVERSFIED EMERGENCY SERVICES, LLC ” Practice Location

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