Provider Demographics
NPI:1740224583
Name:DEPOLI, PATRICIA (MD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:DEPOLI
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 1:4709 GOLF RD STE 1250
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1238
Mailing Address - Country:US
Mailing Address - Phone:847-983-8554
Mailing Address - Fax:847-983-8254
Practice Address - Street 1:4709 GOLF RD STE 1250
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1238
Practice Address - Country:US
Practice Address - Phone:847-983-8554
Practice Address - Fax:847-983-8254
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360946632086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID036094663Medicaid
IL1623290OtherBLUE CROSS BLUE SHIELD
IL541670Medicare ID - Type Unspecified
ID036094663Medicaid