Provider Demographics
NPI:1407816093
Name:NARCISSI, PHILLIP DAVID (DPM)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:DAVID
Last Name:NARCISSI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19841 WOLF ROAD
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448
Mailing Address - Country:US
Mailing Address - Phone:708-479-0790
Mailing Address - Fax:708-479-0792
Practice Address - Street 1:19841 WOLF RD
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448
Practice Address - Country:US
Practice Address - Phone:708-479-0790
Practice Address - Fax:708-479-0792
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016004628213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL09904776OtherBCBS
IL480035160OtherRAILROAD MEDICARE
ILU32161Medicare UPIN
IL978600Medicare PIN
ILK21896Medicare PIN
IL6631840001Medicare NSC
ILIL2878001Medicare PIN
IL5705740001Medicare NSC