Individual
DR. STEPHEN DAVID PESANTI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
912 S WOOD ST, CHICAGO, IL 60612-4300
(123) 456-7890
Mailing address
912 S WOOD ST, CHICAGO, IL 60612-4300
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
036-143917
IL
Other
Enumeration date
06/20/2012
Last updated
03/17/2018
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