Destefani, Thomas

Destefani, Thomas is an individual health care provider with primary practice located at 885 Roosevelt Rd , Glen Ellyn IL 60137-6141. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as his primary health care specialty. Destefani, Thomas can be contacted via phone (630) 790-1555.

Contact Information

Primary practice address
885 Roosevelt Rd Glen Ellyn IL 60137-6141
Phone: (630) 790-1555
Fax: (630) 545-3787
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 36067872 Illinois

Profile Details

NPI number 1588638811
LBN Legal business name Destefani, Thomas
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 14th, 2006
Last updated Apr 3rd, 2013 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1588638811 NPPES
Illinois MEDICAID 036067872
Illinois Other 487450

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