Provider Demographics
NPI:1699775650
Name:CESPEDES, DAVID B (DO)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:B
Last Name:CESPEDES
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 1:4201 WINFIELD RD FL 4
Mailing Address - Street 2:
Mailing Address - City:WARRENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60555-4025
Mailing Address - Country:US
Mailing Address - Phone:331-221-6377
Mailing Address - Fax:
Practice Address - Street 1:130 S MAIN ST STE 201
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-2670
Practice Address - Country:US
Practice Address - Phone:331-221-9001
Practice Address - Fax:331-221-3957
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036103834207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036103834OtherIL STATE LICENSE
IL4515545OtherBCBS IL PROVIDER NUMBER
IL362742950-60123-01Medicaid
IL362742950-60123-01Medicaid
IL036103834OtherIL STATE LICENSE