Provider Demographics
NPI:1942215223
Name:DEPPE, FRANCES GULOTTA (MD)
Entity Type:Individual
Prefix:DR
First Name:FRANCES
Middle Name:GULOTTA
Last Name:DEPPE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:FRANCES
Other - Middle Name:GULOTTA
Other - Last Name:DEPPE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:310 N HAMMES AVE
Mailing Address - Street 2:STE 202
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-8118
Mailing Address - Country:US
Mailing Address - Phone:815-741-2201
Mailing Address - Fax:815-741-2285
Practice Address - Street 1:310 N HAMMES AVE
Practice Address - Street 2:STE 202
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-8118
Practice Address - Country:US
Practice Address - Phone:815-741-2201
Practice Address - Fax:815-741-2285
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036062212208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036062212Medicaid
IL09932105OtherBC/BS
IL09932105OtherBC/BS
ILL96749Medicare ID - Type Unspecified