Provider Demographics
NPI:1760495774
Name:GARAGIOLA, DAVID M (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:GARAGIOLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:14 TODOR CT
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-8390
Mailing Address - Country:US
Mailing Address - Phone:630-654-0693
Mailing Address - Fax:708-923-3611
Practice Address - Street 1:11800 SOUTHWEST HWY
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1029
Practice Address - Country:US
Practice Address - Phone:708-361-0220
Practice Address - Fax:708-923-3611
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E26973Medicare UPIN