Provider Demographics
NPI:1376530634
Name:VAN DORPE, ROSS (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSS
Middle Name:
Last Name:VAN DORPE
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 1:351 DELNOR DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-4220
Mailing Address - Country:US
Mailing Address - Phone:630-232-0280
Mailing Address - Fax:630-232-3895
Practice Address - Street 1:351 DELNOR DR
Practice Address - Street 2:SUITE 100
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-4220
Practice Address - Country:US
Practice Address - Phone:630-232-0280
Practice Address - Fax:630-232-3895
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036097067207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL206147OtherMEDICARE PTAN (GROUP)
IL036097067Medicaid
ILP00944851OtherRR MEDICARE PTAN (INDIVIDUAL)
IL206147056OtherMEDICARE PTAN (INDIVIDUAL)
ILH31470Medicare UPIN
ILL83932Medicare ID - Type Unspecified