Provider Demographics
NPI:1609165745
Name:VANA, PAUL GEOFFREY (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:GEOFFREY
Last Name:VANA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3825 HIGHLAND AVE
Mailing Address - Street 2:STE 303
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1562
Mailing Address - Country:US
Mailing Address - Phone:630-275-7800
Mailing Address - Fax:630-241-9215
Practice Address - Street 1:3825 HIGHLAND AVE STE 303
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-1562
Practice Address - Country:US
Practice Address - Phone:630-275-7800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-29
Last Update Date:2021-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-134065208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery