Provider Demographics
NPI:1609989912
Name:DAYON, DOMINADOR L JR (M D)
Entity Type:Individual
Prefix:DR
First Name:DOMINADOR
Middle Name:L
Last Name:DAYON
Suffix:JR
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:DOMINADOR
Other - Middle Name:L
Other - Last Name:DAYON
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:7906 S CRANDON AVE
Mailing Address - Street 2:SUITE #4
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617-1146
Mailing Address - Country:US
Mailing Address - Phone:773-768-5182
Mailing Address - Fax:773-978-5930
Practice Address - Street 1:7906 S CRANDON AVE
Practice Address - Street 2:SUITE #4
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-1146
Practice Address - Country:US
Practice Address - Phone:773-768-5182
Practice Address - Fax:773-978-5930
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036052751207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036052751Medicaid
IL21606243OtherBLUE CROSS BLUE SHIELD
IL036052751Medicaid