Basic Information
| Provider Information | |||||||||
| NPI: | 1457309817 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DUPAGE VALLEY ANESTHESIOLOGISTS, LTD. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 387 SHUMAN BLVD | ||||||||
| Address2: | SUITE 240 W | ||||||||
| City: | NAPERVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605638450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6308682200 | ||||||||
| FaxNumber: | 6308682240 | ||||||||
| Practice Location | |||||||||
| Address1: | 801 S WASHINGTON ST | ||||||||
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| City: | NAPERVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605407430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6303550450 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2006 | ||||||||
| LastUpdateDate: | 04/28/2017 | ||||||||
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| AuthorizedOfficialLastName: | GENTILE | ||||||||
| AuthorizedOfficialFirstName: | FRANK | ||||||||
| AuthorizedOfficialMiddleName: | M. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6308682200 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0014X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine | 207L00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.