Organization
MEDICAL RESOURCE CENTER LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEVEN J DISANTI D.O. (OFFICER)
(815) 633-4100
Entity
Organization
Contact information
Practice address
6550 E RIVERSIDE BLVD, LOVES PARK, IL 61111-4424
(815) 633-4100
(815) 633-5141
Mailing address
6550 E RIVERSIDE BLVD, LOVES PARK, IL 61111-4424
(815) 633-4100
(815) 633-5141
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
036096167
IL
208D00000X
General Practice Physician
036066772
IL
208D00000X
General Practice Physician
Primary
036067911
IL
Other
Enumeration date
07/27/2006
Last updated
02/13/2024
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