Provider Demographics
NPI: | 1659517597 |
---|---|
Name: | FASTRAC MEDICAL, P.C. |
Entity Type: | Organization |
Organization Name: | FASTRAC MEDICAL, P.C. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | ROBERT |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | FILOTTO |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 815-741-9738 |
Mailing Address - Street 1: | 750 ESSINGTON RD |
Mailing Address - Street 2: | |
Mailing Address - City: | JOLIET |
Mailing Address - State: | IL |
Mailing Address - Zip Code: | 60435-4912 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 815-741-4300 |
Mailing Address - Fax: | 815-725-0600 |
Practice Address - Street 1: | 750 ESSINGTON RD |
Practice Address - Street 2: | |
Practice Address - City: | JOLIET |
Practice Address - State: | IL |
Practice Address - Zip Code: | 60435-4912 |
Practice Address - Country: | US |
Practice Address - Phone: | 815-741-4300 |
Practice Address - Fax: | 815-725-0600 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2008-12-24 |
Last Update Date: | 2009-09-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
IL | 036-079132 | 207P00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207P00000X | Allopathic & Osteopathic Physicians | Emergency Medicine | Group - Multi-Specialty |