Organization
HANSEL M DEBARTOLO JR MD SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HANSEL M DEBARTOLO JR. MD (PRESIDENT)
(630) 859-1818
Entity
Organization
Contact information
Practice address
11 DEBARTOLO DR., SUGAR GROVE, IL 60554
(630) 859-1818
(630) 859-1830
Mailing address
11 DEBARTOLO DR., SUGAR GROVE, IL 60554
(630) 859-1818
(630) 859-1830
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
036-054436
IL
2086S0122X
Plastic and Reconstructive Surgery Physician
036-054436
IL
Other
Enumeration date
04/02/2012
Last updated
05/08/2012
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