Provider Demographics
NPI:1265117204
Name:GOROSPE, DEAN MICHAEL VILLON
Entity type:Individual
Prefix:
First Name:DEAN MICHAEL
Middle Name:VILLON
Last Name:GOROSPE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 N ANNA LN
Mailing Address - Street 2:
Mailing Address - City:ROMEOVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60446-5284
Mailing Address - Country:US
Mailing Address - Phone:773-627-8676
Mailing Address - Fax:
Practice Address - Street 1:1355 REMINGTON RD
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4832
Practice Address - Country:US
Practice Address - Phone:847-262-6906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.027646363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner