1376658161 NPI number — MR. RONALD FRANK AGRIGENTO P.T., A.T.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376658161 NPI number — MR. RONALD FRANK AGRIGENTO P.T., A.T.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AGRIGENTO
Provider First Name:
RONALD
Provider Middle Name:
FRANK
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
P.T., A.T.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376658161
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18465 COWING CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOMEWOOD
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60430-3334
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-206-0584
Provider Business Mailing Address Fax Number:
708-206-1587

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13114 WESTERN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLUE ISLAND
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60406-2439
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-824-0515
Provider Business Practice Location Address Fax Number:
708-824-0516
Provider Enumeration Date:
08/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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