Provider Demographics
NPI:1336297464
Name:DANGLES, GEORGE J (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:J
Last Name:DANGLES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11845 SOUTHWEST HWY
Mailing Address - Street 2:UNIT 12
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463
Mailing Address - Country:US
Mailing Address - Phone:708-274-8700
Mailing Address - Fax:708-361-3410
Practice Address - Street 1:11845 SOUTHWEST HWY
Practice Address - Street 2:UNIT 12
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463
Practice Address - Country:US
Practice Address - Phone:708-274-8700
Practice Address - Fax:708-361-3410
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036059704207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036059704Medicaid
IL036059704Medicaid
ILC41823Medicare UPIN