Healthcare Provider Details

I. General information

NPI: 1316046808
Provider Name (Legal Business Name): PATRICIA DEPOLI, M.D. LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/21/2022
Certification Date: 05/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4709 GOLF RD STE 1250
SKOKIE IL
60076-1238
US

IV. Provider business mailing address

4709 GOLF RD STE 1250
SKOKIE IL
60076-1238
US

V. Phone/Fax

Practice location:
  • Phone: 847-983-8554
  • Fax: 847-983-8254
Mailing address:
  • Phone: 847-983-8554
  • Fax: 847-983-8254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: ANTONIA RAPATAS
Title or Position: OFFICE MANAGER
Credential:
Phone: 847-983-8554