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Individual

MR. DONALD PAUL PRENTISS JR.

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1221 N HIGHLAND AVE, AURORA, IL 60506-1404
(630) 859-8700
Mailing address
1870 W GALENA BLVD, AURORA, IL 60506-4356
(630) 859-6700

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
01074235A
IN
208600000X
Surgery Physician
Primary
036-096029
IL
208600000X
Surgery Physician
K8818
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0072GK
BCBS PROVIDER NUMBER
TX
01
01074235A
LICENSE NUMBER
IN
05
036096029
IL
01
04515143
BCBS#
IL
01
7258113
AETNA PROVIDER NUMBER
TX
01
K8818
LICENSE NUMBER
TX
Enumeration date
10/24/2006
Last updated
11/30/2021
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