Individual
DIANE J. SANTORINEOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5101 N EXECUTIVE DR, PEORIA, IL 61614-4868
(309) 692-1030
Mailing address
5101 N EXECUTIVE DR, PEORIA, IL 61614-4868
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
809840
MEDICARE GROUP #
IL
Enumeration date
07/10/2006
Last updated
02/22/2008
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