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1053426965
DANIEL M PROVENCHER
HINSDALE, IL
NPI
1053426965
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
363AM0700X Physician Assistant, Medical
(Licence: IL 085001850)
Enumeration Date
2006-08-20
Last Update Date
2012-01-12
Business Address
-- DANIEL M PROVENCHER PA-C
911 N ELM ST SUITE 128
HINSDALE, IL 60521-3640
Phone number: 630-789-2260
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Mailing Address
-- DANIEL M PROVENCHER PA-C
911 N ELM ST SUITE 128
HINSDALE, IL 60521-3640
Phone number: 630-789-2260
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