Provider Demographics
NPI:1467181875
Name:FARMER, DONTANE
Entity Type:Individual
Prefix:
First Name:DONTANE
Middle Name:
Last Name:FARMER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6002 S HALSTED ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60621-2107
Mailing Address - Country:US
Mailing Address - Phone:312-564-2383
Mailing Address - Fax:773-874-3611
Practice Address - Street 1:6002 S HALSTED ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60621-2107
Practice Address - Country:US
Practice Address - Phone:312-564-2383
Practice Address - Fax:773-874-3611
Is Sole Proprietor?:No
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator