Provider Demographics
NPI:1487648689
Name:FRANK R DI MARIA DO PC
Entity Type:Organization
Organization Name:FRANK R DI MARIA DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:R
Authorized Official - Last Name:DI MARIA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:773-296-8360
Mailing Address - Street 1:900 OAKMONT LN
Mailing Address - Street 2:STE 100
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5530
Mailing Address - Country:US
Mailing Address - Phone:630-734-0200
Mailing Address - Fax:630-734-1560
Practice Address - Street 1:3525 W PETERSON AVE
Practice Address - Street 2:STE 610
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-3324
Practice Address - Country:US
Practice Address - Phone:773-463-3263
Practice Address - Fax:630-734-1560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL208038Medicare ID - Type Unspecified