Disanto, Richard A

Disanto, Richard A is an individual health care provider with primary practice located at 5201 Willow Springs Rd , La Grange IL 60525-6537. He recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, Physician Assistants & Advanced Practice Nursing Providers / Medical. Physician Assistants & Advanced Practice Nursing Providers / Medical is his primary health care specialty. Disanto, Richard A can be contacted via phone (708) 579-0018.

Contact Information

Primary practice address
5201 Willow Springs Rd La Grange IL 60525-6537
Phone: (708) 579-0018
Fax: (708) 579-7571
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 1046964 Illinois
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X 085001519 Illinois

Profile Details

NPI number 1235290883
LBN Legal business name Disanto, Richard A
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 13th, 2006
Last updated Feb 25th, 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 1235290883 NPPES
Other 1046964 NCCPA

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