Individual
PAUL M DESROSIERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1541 RIVERBOAT CENTER DR, JOLIET, IL 60431-9341
(815) 409-4957
Mailing address
1541 RIVERBOAT CENTER DR, JOLIET, IL 60431-9341
(815) 409-4957
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
01047188A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000744259
ANTHEM PROVIDER NUMBER
IN
05
—
200279370
—
IN
Enumeration date
03/14/2006
Last updated
11/30/2023
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