Provider Demographics
NPI:1396859781
Name:SPITZ, GREGORY A (MD, FACS)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:A
Last Name:SPITZ
Suffix:
Gender:M
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1256 WATERFORD DR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-4510
Mailing Address - Country:US
Mailing Address - Phone:630-820-2727
Mailing Address - Fax:630-820-7427
Practice Address - Street 1:1256 WATERFORD DR
Practice Address - Street 2:SUITE 130
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-4510
Practice Address - Country:US
Practice Address - Phone:630-820-2727
Practice Address - Fax:630-820-7427
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036071367208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
K50962OtherMEDICARE PTAN
K50962OtherMEDICARE PTAN
IL950340Medicare ID - Type Unspecified