Provider Demographics
NPI:1497768865
Name:SANTILLI, MICHAEL DAVID (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DAVID
Last Name:SANTILLI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:7345 PRESCOTT LN
Mailing Address - Street 2:
Mailing Address - City:COUNTRYSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-5037
Mailing Address - Country:US
Mailing Address - Phone:708-354-9405
Mailing Address - Fax:708-354-9140
Practice Address - Street 1:7345 PRESCOTT LN
Practice Address - Street 2:
Practice Address - City:COUNTRYSIDE
Practice Address - State:IL
Practice Address - Zip Code:60525-5037
Practice Address - Country:US
Practice Address - Phone:708-354-9405
Practice Address - Fax:708-354-9140
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36103975207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH46427Medicare UPIN