Basic Information
| Provider Information | |||||||||
| NPI: | 1982752259 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MIRANTI | ||||||||
| FirstName: | SANTI | ||||||||
| MiddleName: | V | ||||||||
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| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7227 | ||||||||
| Address2: | |||||||||
| City: | WESTCHESTER | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601547227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7087862900 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1401 S CALIFORNIA AVE | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606081858 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7735222010 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/05/2007 | ||||||||
| LastUpdateDate: | 09/27/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103G00000X | 071-003767 | IL | N | Behavioral Health & Social Service Providers | Clinical Neuropsychologist | 103TA0700X | 071-003767 | IL | N | Behavioral Health & Social Service Providers | Psychologist | Adult Development & Aging | 103T00000X | 071003767 | IL | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.