Daniel M Provencher PA-C

NPI 1053426965 - Physician Assistant - 363AM0700X

NPI Details
NPI 1053426965
Gender Male
Enumeration Date 08/20/2006
Last Updated 01/12/2012
Entity Type Individual
Active Over 10 years ago
Practice Location
911 N ELM ST
SUITE 128
HINSDALE IL, 60521-3640, US
Phone (630) 789-2260
Fax (630) 789-1584
Business Location
911 N ELM ST
SUITE 128
HINSDALE IL, 60521-3640, US
Phone (630) 789-2260
Fax (630) 789-1584
Toxanomy
Taxonomy Code 363AM0700X
License State Illinois
License Number 085001850
Remove 1053426965 NPI Number
 

According to our database, Daniel M Provencher PA-C NPI is 1053426965, taxonomy code is 363AM0700X and license number is 085001850, license state is located at Illinois. Daniel M Provencher PA-C physically located at 911 N Elm St, Hinsdale IL, 60521-3640. NPI Number Daniel M Provencher PA-C has the Individual type.

Sponsored links

1053426965 NPI number is provided on an as is basis without warranty of any kind. 1053426965 is maintained by the National Plan & Provider Enumeration System. The contents of Daniel M Provencher PA-C are for informational purposes only.