Provider Demographics
NPI:1629774898
Name:DR. ROBERT A. GENDREAU, PLLC
Entity Type:Organization
Organization Name:DR. ROBERT A. GENDREAU, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:GENDREAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:331-285-8341
Mailing Address - Street 1:1113 LODGEPOLE CT
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:IL
Mailing Address - Zip Code:60561-3890
Mailing Address - Country:US
Mailing Address - Phone:415-515-9734
Mailing Address - Fax:
Practice Address - Street 1:2 E 22ND ST STE 305
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-6125
Practice Address - Country:US
Practice Address - Phone:331-285-8341
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty