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:
Health care specialties
| Specialty | Code | License # | 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 18 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1396806840 | NPPES |
| Illinois | MEDICAID | 0160045851 |
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