Provencher, Daniel M

Provencher, Daniel M is an individual health care provider with primary practice located at 911 N Elm St Suite 128, Hinsdale IL 60521-3640. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Medical, which is considered as his primary health care specialty. Provencher, Daniel M can be contacted via phone (630) 789-2260.

Contact Information

Primary practice address
911 N Elm St Suite 128 Hinsdale IL 60521-3640
Phone: (630) 789-2260
Fax: (630) 789-1584
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X 085001850 Illinois

Profile Details

NPI number 1053426965
LBN Legal business name Provencher, Daniel M
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 20th, 2006
Last updated Jan 12th, 2012 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1053426965 NPPES
Illinois Other 362658747 FEDERAL TAX ID

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