Provider Demographics
NPI:1477658862
Name:AZUMA, DENNIS LLOYD (MD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:LLOYD
Last Name:AZUMA
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 1:3745 HIGHLAND AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1584
Mailing Address - Country:US
Mailing Address - Phone:630-369-1501
Mailing Address - Fax:630-309-1560
Practice Address - Street 1:3745 HIGHLAND AVE FL 2
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-1584
Practice Address - Country:US
Practice Address - Phone:630-369-1501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-078550207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036078550Medicaid
IL907002Medicare ID - Type Unspecified
IL036078550Medicaid