Provider Demographics
NPI:1316554835
Name:RIVER FOREST MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:RIVER FOREST MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR IN MEDICINE
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SARANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-771-6611
Mailing Address - Street 1:7353 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:RIVER FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60305-1278
Mailing Address - Country:US
Mailing Address - Phone:708-771-6611
Mailing Address - Fax:708-771-6335
Practice Address - Street 1:7353 NORTH AVE
Practice Address - Street 2:
Practice Address - City:RIVER FOREST
Practice Address - State:IL
Practice Address - Zip Code:60305-1278
Practice Address - Country:US
Practice Address - Phone:708-771-6611
Practice Address - Fax:708-771-6335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036066094OtherLICENSE