DANIEL M PROVENCHER

HINSDALE, IL
NPI1053426965
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy363AM0700X Physician Assistant, Medical
(Licence: IL  085001850)
Enumeration Date2006-08-20
Last Update Date2012-01-12
Business Address
-- DANIEL M PROVENCHER PA-C
911 N ELM ST SUITE 128
HINSDALE, IL 60521-3640
Phone number: 630-789-2260
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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