1841485901 NPI number — DOMINADOR L. DAYON JR., M.D.S.C.

Table of content: (NPI 1841485901)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841485901 NPI number — DOMINADOR L. DAYON JR., M.D.S.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DOMINADOR L. DAYON JR., M.D.S.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841485901
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/16/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11145 MARILYN CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLAND PARK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60467-7467
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-307-3555
Provider Business Mailing Address Fax Number:
773-978-5930

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7906 S CRANDON AVE
Provider Second Line Business Practice Location Address:
SUITE # 4
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60617-1146
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-768-5182
Provider Business Practice Location Address Fax Number:
773-978-5930
Provider Enumeration Date:
09/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DAYON
Authorized Official First Name:
DOMINADOR
Authorized Official Middle Name:
L
Authorized Official Title or Position:
SOLE PROPRIETOR
Authorized Official Telephone Number:
708-307-3555

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  036052751 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 21606243 . This is a "BC/BS PROVIDER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 036052751 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




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