Healthcare Provider Details

I. General information

NPI: 1649385162
Provider Name (Legal Business Name): PATRICIA ANN SANTUCCI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5N467 CURLING POND RD # 533
WAYNE IL
60184-2226
US

IV. Provider business mailing address

5N467 CURLING POND RD # 533
WAYNE IL
60184-2226
US

V. Phone/Fax

Practice location:
  • Phone: 630-377-0822
  • Fax:
Mailing address:
  • Phone: 630-377-0822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036042087
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: