Individual provider · Type 1 NPI
Richard A. Disanto, PA-C
Medical Physician Assistant · La Grange, IL
NPI number
1235290883
Active
Practice location
5201 Willow Springs Rd
La Grange, IL 60525-6537
Fax (708) 579-7571
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Physician Assistant | 363A00000X | 1046964 (IL) |
| Medical Physician Assistant Primary | 363AM0700X | 085001519 (IL) |
Medical Physician Assistant: Definition to come...
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About NPI 1235290883
Richard A. Disanto, PA-C's National Provider Identifier is 1235290883, issued on Dec 13, 2006. The primary taxonomy on file is Medical Physician Assistant (363AM0700X), and the practice location is in La Grange, IL. The record was last updated on Feb 25, 2013.