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General NPI Number Information
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NPI Number | 1457212532
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Entity Type | Individual
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Provider Name | KASSIDY RAE FALDUTO PA-C
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Gender | Female
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Dates
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Enumeration Date | 11/19/2025
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Last Update Date | 11/19/2025
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Provider Practice Location Address
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Address Line | 10811 W 143RD ST STE 150
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City | ORLAND PARK
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State | IL
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Zip | 60467-1945
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Country | US
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Telephone | 708-405-8600
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Fax |
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Provider Business Mailing Address
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Address Line | 1521 GEORGE ST
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City | DOWNERS GROVE
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State | IL
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Zip | 60516-1242
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 085011614
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License Number State | IL
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