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NPI Code Detail

MEDICARE: DR. DANIEL C DESIMONE MD

MEDICARE: DR. DANIEL C DESIMONE MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician036-078524IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1447246822
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DANIEL C DESIMONE MD
Provider Business Mailing Address
First Line : 13755 CICERO AVE
Second Line :
City : CRESTWOOD
State : IL
Zip : 60418-1824
Country : US
Telephone Number : 708-972-7642
Fax Number : 708-925-9179
Provider Business Practice Location Address
First Line : 13755 CICERO AVE
Second Line :
City : CRESTWOOD
State : IL
Zip : 60418-1824
Country : US
Telephone Number : 708-972-7642
Fax Number : 708-925-9179
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2005
Last Update Date : 01/22/2021

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