Provider Demographics
NPI:1275044000
Name:DAMASIUS, DARRON
Entity Type:Individual
Prefix:
First Name:DARRON
Middle Name:
Last Name:DAMASIUS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 LAKE COOK RD STE 350
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-5268
Mailing Address - Country:US
Mailing Address - Phone:847-558-2228
Mailing Address - Fax:
Practice Address - Street 1:500 LAKE COOK RD STE 350
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-5268
Practice Address - Country:US
Practice Address - Phone:847-558-2228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-19
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
372600000X
IL372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion