Healthcare Provider Details

I. General information

NPI: 1104813336
Provider Name (Legal Business Name): ANNEMARIE PAULA DESANTO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 W BOULEVARD
KOKOMO IN
46902-6079
US

IV. Provider business mailing address

2644 CADEN CT
WESTFIELD IN
46074-8527
US

V. Phone/Fax

Practice location:
  • Phone: 765-456-1790
  • Fax: 765-457-3561
Mailing address:
  • Phone: 765-456-1790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number01037590A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: