Provider Demographics
NPI:1295992295
Name:DAVID S. PEZEN, M.D., S.C.
Entity type:Organization
Organization Name:DAVID S. PEZEN, M.D., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:PEZEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-833-3222
Mailing Address - Street 1:360 W BUTTERFIELD RD
Mailing Address - Street 2:SUITE #240
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-5068
Mailing Address - Country:US
Mailing Address - Phone:630-833-3222
Mailing Address - Fax:630-833-3277
Practice Address - Street 1:360 W BUTTERFIELD RD
Practice Address - Street 2:SUITE #240
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-5068
Practice Address - Country:US
Practice Address - Phone:630-833-3222
Practice Address - Fax:630-833-3277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042616683207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty