Provider Demographics
NPI:1972592079
Name:DOMINICIS, HENRY A (MD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:A
Last Name:DOMINICIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:363 W NORTHWEST HWY
Mailing Address - Street 2:CENTURY PLAZA
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60067-2414
Mailing Address - Country:US
Mailing Address - Phone:847-221-4601
Mailing Address - Fax:847-221-4691
Practice Address - Street 1:1051 W RAND RD
Practice Address - Street 2:SUITE 101
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-2315
Practice Address - Country:US
Practice Address - Phone:847-221-4900
Practice Address - Fax:847-221-4996
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-078296207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL748450OtherMEDICARE GROUP PROVIDER
ILL66730Medicare PIN
ILE84421Medicare UPIN