Provider Demographics
NPI:1053435222
Name:FANTO, SALVATORE ANTONIO (MD)
Entity type:Individual
Prefix:
First Name:SALVATORE
Middle Name:ANTONIO
Last Name:FANTO
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:PO BOX 2087
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462
Mailing Address - Country:US
Mailing Address - Phone:708-364-0075
Mailing Address - Fax:708-364-1115
Practice Address - Street 1:11304 W DISTINCTIVE DRIVE
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462
Practice Address - Country:US
Practice Address - Phone:708-479-0005
Practice Address - Fax:708-479-0022
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360765292086S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
532750Medicare ID - Type Unspecified
F55562Medicare UPIN
ILIL4355Medicare PIN