Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0105X | Surgery of the Hand | 036076529 | IL |
NPI | 1053435222 |
---|---|
Provider Name | Salvatore Antonio Fanto |
First Address | Orland Park, IL 60462 |
Second Address | Orland Park, IL 60462 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2007 |
Last Update Date | 26/04/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F55562 | (02) |