Individual
THOMAS DESTEFANI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
885 ROOSEVELT RD, GLEN ELLYN, IL 60137-6141
(630) 790-1555
(630) 545-3787
Mailing address
885 ROOSEVELT RD, GLEN ELLYN, IL 60137-6141
(630) 790-1555
(630) 545-3787
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
36067872
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036067872
—
IL
01
—
487450
MEDICARE PTAN (GROUP)
IL
Enumeration date
02/14/2006
Last updated
04/03/2013
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