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Individual

DR. ADAM FONSECA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
2160 S 1ST AVE, MAYWOOD, IL 60153-3328
(708) 216-5204
Mailing address
2160 S 1ST AVE, MAYWOOD, IL 60153-3328

Taxonomy

Speciality
Code
Description
License number
State
2085R0204X
Vascular & Interventional Radiology Physician
Primary
036.152613
IL
390200000X
Student in an Organized Health Care Education/Training Program
LA

Other

Enumeration date
04/15/2014
Last updated
06/08/2020
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