Individual
DR. JOHN L VISCONTI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1418 CROSS ST, DIV IM MEDICAL ONCOLOGY, STE 180, SHILOH, IL 62269-2914
(618) 607-1340
(618) 622-9724
Mailing address
PO BOX 7412011, CHICAGO, IL 60674-2011
(618) 607-1340
(618) 622-9724
Taxonomy
Speciality
Code
Description
License number
State
207RX0202X
Medical Oncology Physician
Primary
036114479
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
246964001
—
MO
Enumeration date
05/04/2006
Last updated
04/21/2025
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