Provider Demographics
NPI:1528878717
Name:BASGALL, RICHARD P
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:P
Last Name:BASGALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:RICK
Other - Middle Name:
Other - Last Name:BASGALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:265 SUNSET LN
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:IL
Mailing Address - Zip Code:60002-1665
Mailing Address - Country:US
Mailing Address - Phone:224-305-2950
Mailing Address - Fax:
Practice Address - Street 1:265 SUNSET LN
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:IL
Practice Address - Zip Code:60002-1665
Practice Address - Country:US
Practice Address - Phone:224-305-2950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-09
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171WH0202XOther Service ProvidersContractorHome ModificationsGroup - Single Specialty