Provider Demographics
NPI:1679511901
Name:DOHSE, DAVID A (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:DOHSE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:12701 W 143RD ST
Mailing Address - Street 2:SUITE 250
Mailing Address - City:HOMER GLEN
Mailing Address - State:IL
Mailing Address - Zip Code:60491-7715
Mailing Address - Country:US
Mailing Address - Phone:708-301-1400
Mailing Address - Fax:708-301-4295
Practice Address - Street 1:12701 W 143RD ST
Practice Address - Street 2:SUITE 250
Practice Address - City:HOMER GLEN
Practice Address - State:IL
Practice Address - Zip Code:60491-7715
Practice Address - Country:US
Practice Address - Phone:708-301-1400
Practice Address - Fax:708-301-4295
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036068886207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036068886Medicaid
IL036068886Medicaid
ILL62032Medicare PIN