Individual
ANTHONY L SANDIEGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1 DOCTORS PARK, GIBSON CITY, IL 60936-2000
(217) 784-4297
(217) 784-4697
Mailing address
1 DOCTORS PARK, GIBSON CITY, IL 60936-2000
(217) 784-4297
(217) 784-4697
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
036104575
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02727758
BLUE CROSS/BLUE SHIELD
IL
05
—
036104575
—
IL
01
—
370647938
FEIN
—
Enumeration date
07/08/2005
Last updated
12/21/2012
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