| Makenzie Diserio, | |
|
1212 S 2nd St, Dekalb, IL 60115-4435 | |
| (872) 231-3162 | |
| (702) 977-1496 |
| Full Name | Makenzie Diserio |
|---|---|
| Gender | Female |
| Speciality | Physician Assistant |
| Location | 1212 S 2nd St, Dekalb, Illinois |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679146302 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363A00000X | Physician Assistant | 085.009196 (Illinois) | Primary |
| Entity Name | Integrated Rehab Consultants LLC |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1528379195 PECOS PAC ID: 7810184892 Enrollment ID: O20101203000704 |
| Entity Name | Cepamerica Illinois LLP |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1912283110 PECOS PAC ID: 3274793633 Enrollment ID: O20120322000587 |
| Mailing Address | Practice Location Address |
|---|---|
| Makenzie Diserio, Po Box 74008272, Chicago, IL 60674-8272 Ph: (702) 899-0595 | Makenzie Diserio, 1212 S 2nd St, Dekalb, IL 60115-4435 Ph: (872) 231-3162 |
Mrs. Haley Ranae Goulson, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 10 Health Services Dr, Dekalb, IL 60115 Phone: 815-756-5255 Fax: 815-756-9944 |
Sadie Donaghy, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 1 Kish Hospital Dr, Dekalb, IL 60115 Phone: 815-766-7334 Fax: 815-766-9768 |