Provider Demographics
NPI:1922205970
Name:FRANK A DONATELLO RPH DO PC
Entity type:Organization
Organization Name:FRANK A DONATELLO RPH DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:A
Authorized Official - Last Name:DONATELLO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:708-535-6204
Mailing Address - Street 1:6360 W. 159TH STREET
Mailing Address - Street 2:SUITES D & E
Mailing Address - City:OAK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60452-2725
Mailing Address - Country:US
Mailing Address - Phone:708-535-6204
Mailing Address - Fax:
Practice Address - Street 1:6360 WEST 159TH STREET
Practice Address - Street 2:SUITES D & E
Practice Address - City:OAK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60452-2725
Practice Address - Country:US
Practice Address - Phone:708-535-6204
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL211864Medicare PIN