Individual
DAVID P. AGBUNAG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1725 W HARRISON ST, #1063, CHICAGO, IL 60612-3841
(312) 243-4244
(312) 243-2744
Mailing address
1 WESTBROOK CORPORATE CTR, #240, WESTCHESTER, IL 60154-5701
(708) 236-2673
(708) 236-2773
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
085002886
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
209118
MEDICARE PTAN LOCALITY 15
IL
01
—
209119
MEDICARE PTAN LOCALITY 16
IL
Enumeration date
11/08/2006
Last updated
07/25/2008
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