Provider Demographics
NPI: | 1699752741 |
---|---|
Name: | AGNOLI, FRANCIS STEPHEN (MD) |
Entity type: | Individual |
Prefix: | |
First Name: | FRANCIS |
Middle Name: | STEPHEN |
Last Name: | AGNOLI |
Suffix: | |
Gender: | M |
Credentials: | MD |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 1860 PAYSPHERE CIR |
Mailing Address - Street 2: | |
Mailing Address - City: | CHICAGO |
Mailing Address - State: | IL |
Mailing Address - Zip Code: | 60674-0018 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 630-469-9200 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 908 N ELM ST |
Practice Address - Street 2: | STE. 301 |
Practice Address - City: | HINSDALE |
Practice Address - State: | IL |
Practice Address - Zip Code: | 60521-3635 |
Practice Address - Country: | US |
Practice Address - Phone: | 630-323-3540 |
Practice Address - Fax: | |
Is Sole Proprietor?: | Not Answered |
Enumeration Date: | 2005-12-29 |
Last Update Date: | 2007-07-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
IL | 207R00000X, 207RE0101X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Not Answered | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | |
Not Answered | 207RE0101X | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
IL | L72277 | Medicare ID - Type Unspecified | |
IL | C39009 | Medicare UPIN |