Individual
DR. LARRY WAYNE DESCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
9555 S 52ND AVE, OAK LAWN, IL 60453-3054
(847) 318-9330
(708) 876-1561
Mailing address
9555 S 52ND AVE, OAK LAWN, IL 60453-3054
(847) 318-9330
(708) 876-1561
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
036093057
IL
2080P0006X
Developmental - Behavioral Pediatrics Physician
Primary
036-093057
IL
2080P0008X
Pediatric Neurodevelopmental Disabilities Physician
036093057
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036093057
STATE LICENSE
IL
01
—
14D0419824
CLIA
IL
Enumeration date
08/29/2006
Last updated
12/17/2021
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