Provider Demographics
NPI:1457465866
Name:G. SPITZ, M.D., LTD
Entity Type:Organization
Organization Name:G. SPITZ, M.D., LTD
Other - Org Name:SPITZ & BRAXTON, LTD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LORNELL
Authorized Official - Middle Name:E
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:605-274-0217
Mailing Address - Street 1:1256 WATERFORD DR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-4510
Mailing Address - Country:US
Mailing Address - Phone:630-820-2727
Mailing Address - Fax:630-820-7427
Practice Address - Street 1:1256 WATERFORD DR
Practice Address - Street 2:SUITE 130
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-4510
Practice Address - Country:US
Practice Address - Phone:630-820-2727
Practice Address - Fax:630-820-7427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No202K00000XAllopathic & Osteopathic PhysiciansPhlebologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
216477OtherPTAN MEDICARE