Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 038.004840 | IL |
NPI | 1467610691 |
---|---|
Provider Name | Dr. Frank George Antonino |
First Address | Westmont, IL 60559-1746 |
Second Address | Westmont, IL 60559-1746 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2008 |
Last Update Date | 23/05/2008 |