Provider Demographics
NPI:1124135017
Name:SANTILLI, SUSAN LISA (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:LISA
Last Name:SANTILLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 BAKER LN
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:CO
Mailing Address - Zip Code:80516-9061
Mailing Address - Country:US
Mailing Address - Phone:303-828-9220
Mailing Address - Fax:
Practice Address - Street 1:12001 TEJON ST
Practice Address - Street 2:#124
Practice Address - City:NORTHGLENN
Practice Address - State:CO
Practice Address - Zip Code:80234-2310
Practice Address - Country:US
Practice Address - Phone:303-254-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO32837207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine