Provider Demographics
NPI:1023099082
Name:SANTILLI, GREGG M (MD)
Entity type:Individual
Prefix:
First Name:GREGG
Middle Name:M
Last Name:SANTILLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8440 WALNUT HILL LN
Mailing Address - Street 2:SUITE 350
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-3833
Mailing Address - Country:US
Mailing Address - Phone:214-373-1773
Mailing Address - Fax:214-373-1316
Practice Address - Street 1:3600 COMMUNICATIONS PKWY
Practice Address - Street 2:SUITE 675
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8157
Practice Address - Country:US
Practice Address - Phone:972-473-7544
Practice Address - Fax:972-473-7545
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1922207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1206104Medicaid
TX8G4481Medicare PIN
TXF75545Medicare UPIN
TX8G4480Medicare PIN