Provider Demographics
NPI:1093727570
Name:DREYFUSS, DAVID (MD,)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:DREYFUSS
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:DR
Other - First Name:DAVID
Other - Middle Name:A
Other - Last Name:DREYFUSS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:17850 KEDZIE AVE
Mailing Address - Street 2:SUITE 2200
Mailing Address - City:HAZEL CREST
Mailing Address - State:IL
Mailing Address - Zip Code:60429-2058
Mailing Address - Country:US
Mailing Address - Phone:708-799-9782
Mailing Address - Fax:708-799-8175
Practice Address - Street 1:17850 KEDZIE AVE
Practice Address - Street 2:SUITE 2200
Practice Address - City:HAZEL CREST
Practice Address - State:IL
Practice Address - Zip Code:60429-2058
Practice Address - Country:US
Practice Address - Phone:708-799-9782
Practice Address - Fax:708-799-8175
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01039930A208200000X
IL208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILE80208Medicare UPIN
IL204831Medicare ID - Type Unspecified