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NPI Code Detail

MEDICARE: DIANE J. SANTORINEOS

MEDICARE:   DIANE J. SANTORINEOS
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
1208000000XPediatrics PhysicianIL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1809840OTHERILMEDICARE GROUP #

General Provider Information

NPI Number : 1518991066
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIANE J. SANTORINEOS
Provider Business Mailing Address
First Line : 5101 N EXECUTIVE DR
Second Line :
City : PEORIA
State : IL
Zip : 61614-4868
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5101 N EXECUTIVE DR
Second Line :
City : PEORIA
State : IL
Zip : 61614-4868
Country : US
Telephone Number : 309-692-1030
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/10/2006
Last Update Date : 02/22/2008

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Directions to “ DIANE J. SANTORINEOS ” Practice Location

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