Healthcare Provider Details

I. General information

NPI: 1336569391
Provider Name (Legal Business Name): ANTONIO F PUGLIESE, DN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2014
Last Update Date: 04/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 ROSE ST STE A
FRANKLIN PARK IL
60131-2013
US

IV. Provider business mailing address

3535 ROSE ST STE A
FRANKLIN PARK IL
60131-2013
US

V. Phone/Fax

Practice location:
  • Phone: 708-308-8669
  • Fax:
Mailing address:
  • Phone: 708-308-8669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number198000413
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code172P00000X
TaxonomyNaprapath
License Number181000237
License Number StateIL

VIII. Authorized Official

Name: ANTONIO F PUGLIESE
Title or Position: OWNER
Credential: DN
Phone: 708-308-8669