Individual
DR. RICHARD JOSEPH FANTUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
836 W WELLINGTON AVE, CHICAGO, IL 60657-5147
(773) 296-7033
Mailing address
29373 NETWORK PL, CHICAGO, IL 60673-1293
Taxonomy
Speciality
Code
Description
License number
State
2086S0102X
Surgical Critical Care Physician
Primary
036064949
IL
2086S0127X
Trauma Surgery Physician
036064949
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036064949
—
IL
Enumeration date
07/07/2006
Last updated
04/08/2025
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