Provider Demographics
NPI:1528485174
Name:PFAENDTNER, TREVOR JOHN (DO)
Entity type:Individual
Prefix:MR
First Name:TREVOR
Middle Name:JOHN
Last Name:PFAENDTNER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15900 W 127TH ST.
Mailing Address - Street 2:SUITE 221A
Mailing Address - City:LEMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60439
Mailing Address - Country:US
Mailing Address - Phone:312-421-1016
Mailing Address - Fax:312-421-1017
Practice Address - Street 1:15900 W 127TH ST.
Practice Address - Street 2:SUITE 221A
Practice Address - City:LEMONT
Practice Address - State:IL
Practice Address - Zip Code:60439
Practice Address - Country:US
Practice Address - Phone:312-421-1016
Practice Address - Fax:312-421-1017
Is Sole Proprietor?:No
Enumeration Date:2014-03-20
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036142825207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine