Basic Information
| Provider Information | |||||||||
| NPI: | 1689810855 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SABATINO | ||||||||
| FirstName: | MARC | ||||||||
| MiddleName: | LOUIS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4225 LINCOLNSHIRE DR STE B | ||||||||
| Address2: | |||||||||
| City: | MOUNT VERNON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 628642157 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182422317 | ||||||||
| FaxNumber: | 6182429710 | ||||||||
| Practice Location | |||||||||
| Address1: | 2351 FRANK SCOTT PKWY E | ||||||||
| Address2: | |||||||||
| City: | SHILOH | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622697457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6363174005 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/18/2008 | ||||||||
| LastUpdateDate: | 10/26/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 0102202454 | VA | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 208100000X | 5101020702 | MI | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 208100000X | 036148596 | IL | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.