Individual
RICHARD FASSOLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1932 S MAIN ST, EUREKA, IL 61530-1666
(309) 467-5000
(309) 467-1500
Mailing address
5908 GREENVIEW RD, LISLE, IL 60532-2904
(815) 474-2678
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085-000933
IL
Other
Enumeration date
10/16/2012
Last updated
06/15/2016
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