Individual
GUY AGOSTINO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
512 W BURLINGTON AVE, SUITE 100, LA GRANGE, IL 60525-2221
(630) 390-1240
(630) 390-1247
Mailing address
PO BOX 713260, CHICAGO, IL 60677-1260
(630) 469-9200
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
036075612
IL
207Q00000X
Family Medicine Physician
Primary
036075612
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036075612
—
IL
Enumeration date
04/17/2006
Last updated
08/02/2023
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