Individual provider · Type 1 NPI

Daniel M. Provencher, PA-C

Medical Physician Assistant · Hinsdale, IL

NPI number 1053426965 Active

Practice location

911 N Elm St, Suite 128
Hinsdale, IL 60521-3640

Call (630) 789-2260 Map

Fax (630) 789-1584

Specialties and licenses

TaxonomyCodeLicense
Medical Physician Assistant Primary 363AM0700X085001850 (IL)

Medical Physician Assistant: Definition to come...

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About NPI 1053426965

Daniel M. Provencher, PA-C's National Provider Identifier is 1053426965, issued on Aug 20, 2006. The primary taxonomy on file is Medical Physician Assistant (363AM0700X), and the practice location is in Hinsdale, IL. The record was last updated on Jan 12, 2012.