Provider Demographics
NPI:1841485901
Name:DOMINADOR L. DAYON JR., M.D.S.C.
Entity type:Organization
Organization Name:DOMINADOR L. DAYON JR., M.D.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DOMINADOR
Authorized Official - Middle Name:L
Authorized Official - Last Name:DAYON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:708-307-3555
Mailing Address - Street 1:11145 MARILYN CT
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-7467
Mailing Address - Country:US
Mailing Address - Phone:708-307-3555
Mailing Address - Fax:773-978-5930
Practice Address - Street 1:7906 S CRANDON AVE
Practice Address - Street 2:SUITE # 4
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-1146
Practice Address - Country:US
Practice Address - Phone:773-768-5182
Practice Address - Fax:773-978-5930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036052751207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL21606243OtherBC/BS PROVIDER
IL036052751Medicaid
IL21606243OtherBC/BS PROVIDER