Provider Demographics
NPI:1326057969
Name:PARK, DAVID H (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:H
Last Name:PARK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5201 WILLOW SPRINGS RD
Mailing Address - Street 2:SUITE #290
Mailing Address - City:LA GRANGE HIGHLANDS
Mailing Address - State:IL
Mailing Address - Zip Code:60525-6537
Mailing Address - Country:US
Mailing Address - Phone:708-579-0018
Mailing Address - Fax:708-579-7571
Practice Address - Street 1:5201 WILLOW SPRINGS RD
Practice Address - Street 2:SUITE #290
Practice Address - City:LA GRANGE HIGHLANDS
Practice Address - State:IL
Practice Address - Zip Code:60525-6537
Practice Address - Country:US
Practice Address - Phone:708-579-0018
Practice Address - Fax:708-579-7571
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2021-03-25
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Provider Licenses
StateLicense IDTaxonomies
IL036-114009208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
403270OtherGROUP PTAN
399690OtherGROUP PTAN
403270OtherGROUP PTAN