Healthcare Provider Details

I. General information

NPI: 1700949856
Provider Name (Legal Business Name): GINA MARIE BAKIARES-SANTORI DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 11/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 OGDEN AVE SUITE 140
AURORA IL
60504
US

IV. Provider business mailing address

4236 WHITE BIRCH DR
LISLE IL
60532-1251
US

V. Phone/Fax

Practice location:
  • Phone: 630-851-1329
  • Fax: 630-851-8837
Mailing address:
  • Phone: 630-852-0888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number016003316
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: