MEDICARE: ANTHONY DESANTIS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	036-092846	IL
2	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	MD00046201	WA

General Provider Information

NPI Number	:	1235193178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY DESANTIS MD

Provider Business Mailing Address
First Line	:	4225 ROOSEVELT WAY NE
Second Line	:	STE 101
City	:	SEATTLE
State	:	WA
Zip	:	98105-6099
Country	:	US
Telephone Number	:	206-598-4882
Fax Number	:	206-598-4976

Provider Business Practice Location Address
First Line	:	4225 ROOSEVELT WAY NE
Second Line	:	STE 101
City	:	SEATTLE
State	:	WA
Zip	:	98105-6099
Country	:	US
Telephone Number	:	206-598-4882
Fax Number	:	206-598-4976

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2006
Last Update Date	:	11/14/2011

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