Provider Demographics
NPI:1891770624
Name:ASENSIO, DENNIS S (MD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:S
Last Name:ASENSIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2765 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-3280
Mailing Address - Country:US
Mailing Address - Phone:630-579-9817
Mailing Address - Fax:630-579-9846
Practice Address - Street 1:2765 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-3280
Practice Address - Country:US
Practice Address - Phone:630-579-9817
Practice Address - Fax:630-579-9846
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-075848207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36075848Medicaid
110210903OtherRAILROAD MEDICARE
K44872Medicare PIN
110210903OtherRAILROAD MEDICARE