Disomma, Mary M

Disomma, Mary M is an sole proprietor health care provider with primary practice located at 1100 Lake St Suite 248, Oak Park IL 60301-1015. She recently has only one registered license in Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery, which is considered as her primary health care specialty. Disomma, Mary M can be contacted via phone (708) 383-5554.

Contact Information

Primary practice address
1100 Lake St Suite 248 Oak Park IL 60301-1015
Phone: (708) 383-5554
Fax: (708) 383-9321
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery 213ES0103X Illinois

Profile Details

NPI number 1396806840
LBN Legal business name Disomma, Mary M
Credentials Doctor of Podiatric Medicine (DPM)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Dec 12th, 2006
Last updated Jul 8th, 2007 - about 17 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 1396806840 NPPES
Illinois MEDICAID 0160045851

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