Individual
JENNA SARANTAKOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
2000 E LAYTON AVE, ST FRANCIS, WI 53235-6053
(414) 744-6589
(414) 747-8848
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(414) 744-6589
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
81205
WI
207Q00000X
Family Medicine Physician
R-11880
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100246712
—
WI
Enumeration date
06/08/2020
Last updated
11/14/2023
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