Provider Demographics
NPI:1467553008
Name:SANTILLI, JAMIE D (MD)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:D
Last Name:SANTILLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 WASHINGTON AVE SE
Mailing Address - Street 2:UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-2924
Mailing Address - Country:US
Mailing Address - Phone:612-884-0649
Mailing Address - Fax:
Practice Address - Street 1:580 RICE ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55103-2148
Practice Address - Country:US
Practice Address - Phone:651-227-6551
Practice Address - Fax:651-665-0684
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN30179207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1011317OtherPREFERRED ONE
WI31506900Medicaid
MNHP11368OtherHEALTHPARTNERS NUMBER
MN105412OtherUCARE PROVIDER NUMBER
IA1536763Medicaid
MN01-02033OtherMEDICA CHOICE/DUAL/PTCH #
MN53A27SAOtherBCBS OF MN PROVIDER NUMBE
MN609882700Medicaid
MN768334OtherAMERICA'S PPO NUMBER
MN105412OtherUCARE PROVIDER NUMBER
MNA94349Medicare UPIN
MN609882700Medicaid