Basic Information
| Provider Information | |||||||||
| NPI: | 1588631931 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DALESSIO | ||||||||
| FirstName: | ANTHONY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1901 BUTTERFIELD RD | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | DOWNERS GROVE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605157915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6307252768 | ||||||||
| FaxNumber: | 6307252783 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 PENN CENTER BLVD | ||||||||
| Address2: | SUITE 602 | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152355613 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4128233782 | ||||||||
| FaxNumber: | 4128235041 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/03/2006 | ||||||||
| LastUpdateDate: | 02/25/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | MD056882L | PA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | 202K00000X | MD056882L | PA | N | Allopathic & Osteopathic Physicians | Phlebology |
ID Information
| ID | Type | State | Issuer | Description | MD056882L | 01 | PA | LICENSE NUMBER | OTHER | 0015373520005 | 05 | PA | MEDICAID |