Basic Information
| Provider Information | |||||||||
| NPI: | 1407097330 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DESIATO | ||||||||
| FirstName: | LINDSAY | ||||||||
| MiddleName: | CHRISTINE | ||||||||
| NamePrefix: | |||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9318 STATE ROUTE 14 | ||||||||
| Address2: | 1ST FLOOR | ||||||||
| City: | STREETSBORO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442415224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306263455 | ||||||||
| FaxNumber: | 3306264189 | ||||||||
| Practice Location | |||||||||
| Address1: | 9318 STATE ROUTE 14 | ||||||||
| Address2: | 1ST FLOOR | ||||||||
| City: | STREETSBORO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442415224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306263455 | ||||||||
| FaxNumber: | 3306264189 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2009 | ||||||||
| LastUpdateDate: | 07/11/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 34-010422 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.