Edward J Fesco MD SC

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

036034820 Issued in IL

Legal business name

EDWARD J FESCO MD SC

Practice address

206 Marquette St
Room 206
Lasalle, IL 61301

Phone

(815) 223-3616

Fax

(815) 223-0550

NPI assigned

May 21, 2008

Last updated

May 21, 2008By the provider in NPPES

Organization subpart

Yes

Parent organization

EDWARD J FESCO MD SCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Edward John Fesco, MD

Title

Solo Practioner

Phone

(815) 223-3616

Specialties & licenses 1

Addresses

Other identifiers 3

Part of

Edward J Fesco MD SC

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1211328000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211328000000",
    "number": "1659538270",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "206 MARQUETTE ST",
            "address_2": "ROOM 218",
            "city": "LASALLE",
            "state": "IL",
            "postal_code": "61301",
            "telephone_number": "815-223-3616",
            "fax_number": "815-223-0550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "206 MARQUETTE ST",
            "address_2": "ROOM 206",
            "city": "LASALLE",
            "state": "IL",
            "postal_code": "61301",
            "telephone_number": "815-223-3616",
            "fax_number": "815-223-0550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDWARD J FESCO MD SC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EDWARD J FESCO MD SC",
        "enumeration_date": "2008-05-21",
        "last_updated": "2008-05-21",
        "status": "A",
        "authorized_official_last_name": "FESCO",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "SOLO PRACTIONER",
        "authorized_official_telephone_number": "815-223-3616",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IL",
            "license": "036034820",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC & BS",
            "identifier": "05000151",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MED",
            "identifier": "021757686",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036034820",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jessica Marie Dergance, LCSW
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• Surgery Physician in La Salle, IL
• Providers in La Salle, IL by specialty
• Surgery Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.