Individual
MAKENZIE DISERIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1212 S 2ND ST, DEKALB, IL 60115-4435
(872) 231-3162
(702) 977-1496
Mailing address
PO BOX 74008272, CHICAGO, IL 60674-8272
(702) 899-0595
(702) 977-1496
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085.009196
IL
Other
Enumeration date
07/20/2021
Last updated
10/10/2025
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