Provider Demographics
NPI:1700949856
Name:BAKIARES-SANTORI, GINA MARIE (DPM)
Entity type:Individual
Prefix:DR
First Name:GINA
Middle Name:MARIE
Last Name:BAKIARES-SANTORI
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4236 WHITE BIRCH DR
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-1251
Mailing Address - Country:US
Mailing Address - Phone:630-852-0888
Mailing Address - Fax:
Practice Address - Street 1:2020 OGDEN AVE
Practice Address - Street 2:SUITE 140
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504
Practice Address - Country:US
Practice Address - Phone:630-851-1329
Practice Address - Fax:630-851-8837
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016003316213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016003316Medicaid
T37738Medicare UPIN
IL016003316Medicaid
IL0275710003Medicare NSC