Healthcare Provider Details

I. General information

NPI: 1487979332
Provider Name (Legal Business Name): ANTHONY D MURINO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2010
Last Update Date: 04/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 MAPLE RD
JOLIET IL
60432-1439
US

IV. Provider business mailing address

PO BOX 1208
BEDFORD PARK IL
60499-1208
US

V. Phone/Fax

Practice location:
  • Phone: 815-740-1100
  • Fax:
Mailing address:
  • Phone: 630-734-0200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036-123166
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: