Provider Demographics
NPI:1376594655
Name:AMOROSO, PANTALEO J (MD)
Entity type:Individual
Prefix:DR
First Name:PANTALEO
Middle Name:J
Last Name:AMOROSO
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 1:675 W NORTH AVE
Mailing Address - Street 2:SUITE 609
Mailing Address - City:MELROSE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60160-1634
Mailing Address - Country:US
Mailing Address - Phone:708-450-5770
Mailing Address - Fax:708-681-7675
Practice Address - Street 1:675 W NORTH AVE
Practice Address - Street 2:SUITE 609
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-1634
Practice Address - Country:US
Practice Address - Phone:708-450-5770
Practice Address - Fax:708-681-7675
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3647630174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL21609229OtherBCBS IL PROVIDER NO.
IL3647630OtherLICENSE NUMBER
IL701258OtherUNITED HEALTHCARE
IL701258OtherUNITED HEALTHCARE
IL3647630OtherLICENSE NUMBER