Individual
RICHARD A DISANTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
5201 WILLOW SPRINGS RD, LA GRANGE, IL 60525-6537
(708) 579-0018
(708) 579-7571
Mailing address
5201 WILLOW SPRINGS RD, LA GRANGE, IL 60525
(708) 579-0018
(708) 579-7571
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
1046964
IL
363AM0700X
Medical Physician Assistant
Primary
085001519
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1046964
NCCPA
—
Enumeration date
12/13/2006
Last updated
02/25/2013
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