LEE MICHAEL DE DORE (NPI# 1790017085) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790017085 |
| Entity Type | Individual |
| Full Name | LEE MICHAEL DE DORE |
| Credential | PA |
| Practice Address |
25 N Winfield Road Suite 505 Winfield IL 60190 |
| Mailing Address |
1 Westbrook Corporate Ctr Ste 240 Westchester IL 60154-5745 |
| Practice Telephone | 6306825653 |
| Practice Fax Number | 6306828946 |
| Mailing Telephone | 6306825653 |
| Mailing Fax Number | 6306828946 |
| Enumeration Date | 2010-02-11 |
| Last Update Date | 2017-06-16 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
085003692 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
25 N WINFIELD ROAD SUITE 505 |
| City | WINFIELD |
| State | IL |
| Zip Code | 60190 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073514360 | Thomas A. Eiseman | Emergency Medicine | 25 N Winfield Road, Winfield, IL 60190 | 2005-08-09 |
| 1750813580 | Ingrid Kanady | Nurse Practitioner | 25 N Winfield Road, Winfield, IL 60190-1295 | 2017-03-30 |
| 1447647201 | Sarah Liljeberg | Nurse Practitioner | 25 N Winfield Road, Ste 420, Winfield, IL 60190-1295 | 2015-04-20 |
| 1174878896 | Kristin Lynn Rosenberger | Physical Therapist | 25 N Winfield Road, Winfield, IL 60190-1295 | 2012-07-18 |
| 1831463975 | Central Dupage Hospital | General Acute Care Hospital | 25 N Winfield Road, Winfield, IL 60190 | 2012-03-07 |
| 1841587599 | Brian Christopher Fort | Emergency Medicine | 25 N Winfield Road, Winfield, IL 60190 | 2011-07-01 |
| 1174821201 | Andrea Fuller | Nurse Practitioner | 25 N Winfield Road, Winfield, IL 60190 | 2011-03-15 |
| 1871823971 | Jennifer Aileen Chiaramonte | Speech-Language Pathologist | 25 N Winfield Road, Winfield, IL 60190 | 2010-01-12 |
| 1194981019 | Joshua A Blomgren | Family Medicine | 25 N Winfield Road, Winfield, IL 60190-1295 | 2008-07-30 |
| 1679735104 | Jeffrey Michael Ksiazek | Otolaryngology | 25 N Winfield Road, #519, Winfield, IL 60190 | 2008-06-26 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316592256 | Kelly Marie Jung | Nurse Practitioner | 25 N Winfield Rd Ste 500, Winfield, IL 60190 | 2019-08-07 |
| 1003379660 | Genevieve Goro | Speech-Language Pathologist | In220 Pleasant Hill Rd, Winfield, IL 60190 | 2019-04-10 |
| 1730670175 | Brian J Fischer | Physical Therapist | 26w228 Geneva Road, Winfield, IL 60190 | 2018-05-22 |
| 1730625500 | Johnson Medical Services S.c. | Family Medicine | 27 W 132 Barnes Ave/, Winfield, IL 60190 | 2017-01-17 |
| 1992253843 | Dr. Roy Settergren S.c. | Chiropractor | 27w123 Redbud Lane, Winfield, IL 60190 | 2016-09-20 |
| 1952855223 | Terri Hannemann | Nurse Practitioner | 25 North Winfield Road, Central Dupage Hospital, Winfield, IL 60190 | 2016-08-04 |
| 1154730737 | Cynthia Koeppen | Registered Nurse | 27w281 Winfield Rd, Winfield, IL 60190 | 2014-08-07 |
| 1992117634 | Jonathan Wang | Internal Medicine | 25 N Winfield Rd Ste 202, Winfield, IL 60190 | 2014-05-29 |
| 1689005977 | Erin Sands | Physician Assistant | 25 N Winfield Rd Ste 519, Winfield, IL 60190 | 2013-12-11 |
| 1790120285 | Clarity Health & Wellness | Social Worker | 1 N. 121 County Farm Road, Suite 220, Winfield, IL 60190 | 2013-05-09 |
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| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558881110 | Paula Connolly | Physician Assistant | 25 N Winfield Rd, Winfield, IL 60190-1222 | 2017-06-26 |
| 1841587045 | Lauren Marie Opila | Physician Assistant | 25 N. Winfield Rd, Ste 505, Winfield, IL 60910 | 2011-07-08 |
| 1649436783 | April Rene Penkala | Physician Assistant | 25 N Winfield Rd, Winfield, IL 60190-1222 | 2008-07-29 |
| 1396879672 | Jesse Kong | Physician Assistant | 25 N Winfield Rd, Winfield, IL 60190-1295 | 2007-03-16 |
| 1720029929 | Sonal Vithal Patel | Physician Assistant | 25 N. Winfield Rd., Winfield, IL 60190-1295 | 2006-06-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477169522 | Priority Assist Pllc | Physician Assistant | 48 Glenda Ln, Plano, IL 60545-9652 | 2020-09-23 |
| 1154944478 | Diana Goldak | Physician Assistant | 3855 N Parkway Dr Apt 3a, Northbrook, IL 60062-7218 | 2020-05-20 |
| 1033742580 | Colleen Courtney | Physician Assistant | 218 S Driftwood Trl, Mchenry, IL 60050-5454 | 2020-02-12 |
| 1326678962 | Nina Kodros | Physician Assistant | 301 Madison St Ste 280, Joliet, IL 60435-6672 | 2020-01-23 |
| 1689218190 | Jennifer Richman | Physician Assistant | 1890 Silver Cross Blvd Ste 410, New Lenox, IL 60451-9547 | 2019-10-29 |
| 1710547625 | Nadia Khan | Physician Assistant | 4543 N Malden St Apt 1s, Chicago, IL 60640-5687 | 2019-06-13 |
| 1962065516 | Jorge Mantilla | Physician Assistant | 5540 N Kimball Ave Apt 3e, Chicago, IL 60625-4674 | 2019-04-18 |
| 1013479955 | Leah Rae Prager | Physician Assistant | 4400 W. 95th St., Attn: Pediatric General Surgery, Oak Lawn, IL 60453 | 2019-04-01 |
| 1770041949 | Laura Ann Ryan | Physician Assistant | 840 S Wood St Ste 417, Chicago, IL 60612-4325 | 2019-03-06 |
| 1548739782 | Helen Finke | Physician Assistant | 880 W Central Rd Ste 3300, Arlington Heights, IL 60005-2366 | 2018-11-16 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.