Healthcare Provider Details

I. General information

NPI: 1740224583
Provider Name (Legal Business Name): PATRICIA DEPOLI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
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 Number036094663
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: