Provider Demographics
NPI:1801843156
Name:DONATELLO, FRANK A (DO)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:A
Last Name:DONATELLO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6360 W. 159TH STREET
Mailing Address - Street 2:SUITES D & E
Mailing Address - City:OAK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60452-2725
Mailing Address - Country:US
Mailing Address - Phone:708-535-6204
Mailing Address - Fax:708-535-6431
Practice Address - Street 1:6360 W. 159TH STREET
Practice Address - Street 2:SUITES D & E
Practice Address - City:OAK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60452-2725
Practice Address - Country:US
Practice Address - Phone:708-535-6204
Practice Address - Fax:708-535-6431
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036083282207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK18400Medicare PIN
ILF25077Medicare UPIN