Doctor Name: | DR. SIDDHARTHA A DANTE |
NPI Number: | 1548523772 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | 125-060812 |
Business Practice Address: | 5841 S Maryland Ave, Mc 7082 Chicago, IL - 60637 |
Business Phone Number: | 8047026840 |
Business Fax Number: | |
Mailing Address: | 5841 S Maryland Ave,, Mc 7082 CHICAGO |
State: | IL |
Postal Code: | 60637 |
Phone Number: | 8047026840 |
Fax Number: | |
NPI Enumeration Date: | 06/21/2012 |
NPI Last Update Date: | 09/13/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 125-060812 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |