Provider Demographics
NPI:1861654857
Name:SANCHEZ, DOMINIQUE (DO)
Entity Type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:
Last Name:SANCHEZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA
Mailing Address - State:IL
Mailing Address - Zip Code:62691-1519
Mailing Address - Country:US
Mailing Address - Phone:217-452-3057
Mailing Address - Fax:217-452-7245
Practice Address - Street 1:331 S MAIN ST
Practice Address - Street 2:
Practice Address - City:VIRGINIA
Practice Address - State:IL
Practice Address - Zip Code:62691-1519
Practice Address - Country:US
Practice Address - Phone:217-452-3057
Practice Address - Fax:217-452-7245
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036128630207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine