Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223G0001X | General Practice | 1914975 | IL |
N | 213EG0000X | General Practice | 1914975 | IL |
Y | 1223G0001X | General Practice | DDS-09357 | IA |
Y | 213EG0000X | General Practice | DDS-09357 | IA |
NPI | 1003031477 |
---|---|
Provider Name | Michael L Santucci |
First Address | Iowa City, IA 52242-1001 |
Second Address | Iowa City, IA 52242-1001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2007 |
Last Update Date | 13/07/2020 |