Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | IL |
NPI | 1134233299 |
---|---|
Provider Name | Raymond Donald Santucci |
First Address | Wayne, IL 60184-2226 |
Second Address | Wayne, IL 60184-2226 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2006 |
Last Update Date | 08/07/2007 |