Healthcare Provider Details

I. General information

NPI: 1154641710
Provider Name (Legal Business Name): MELISSA SAENZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2010
Last Update Date: 03/24/2020
Certification Date: 03/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4710 MAIN ST STE 4
LISLE IL
60532-1752
US

IV. Provider business mailing address

4710 MAIN ST STE 4
LISLE IL
60532-1752
US

V. Phone/Fax

Practice location:
  • Phone: 630-493-9300
  • Fax:
Mailing address:
  • Phone: 630-493-9300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: