Dettore, Diamond Donald

Dettore, Diamond Donald is an sole proprietor health care provider with primary practice located at 4705 Willow Springs Rd Ste 203 , La Grange IL 60525-6150. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Dettore, Diamond Donald can be contacted via phone (708) 795-1520.

Contact Information

Primary practice address
4705 Willow Springs Rd Ste 203 La Grange IL 60525-6150
Phone: (708) 795-1520
Fax: (708) 795-1543
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 036039227 Illinois

Profile Details

NPI number 1285646588
LBN Legal business name Dettore, Diamond Donald
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Aug 13th, 2006
Last updated Oct 8th, 2018 - about 6 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 1285646588 NPPES
Illinois Other 21608845 BCBS

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