Provider Demographics
NPI:1477766186
Name:RIVER FOREST MEDICAL ASSOC INC
Entity Type:Organization
Organization Name:RIVER FOREST MEDICAL ASSOC INC
Other - Org Name:WILLIAM J SARANTOS,MD
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:SARANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-867-6087
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:708-867-6087
Mailing Address - Fax:708-867-6032
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:708-867-6087
Practice Address - Fax:708-867-6032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036066094207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036066094Medicaid
IL1023192671OtherNPI ( PERSONAL)
IL0031601446OtherBCBS PROVIDER ID #
IL036066094Medicaid
IL0031601446OtherBCBS PROVIDER ID #