Provider Demographics
NPI:1366232324
Name:SANTILLO, PAUL ANTHONY (MDIV)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:ANTHONY
Last Name:SANTILLO
Suffix:
Gender:M
Credentials:MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1733 E CENTRAL ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:SILOAM SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72761-2969
Mailing Address - Country:US
Mailing Address - Phone:479-340-2616
Mailing Address - Fax:
Practice Address - Street 1:436 COURT ST STE B
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-6303
Practice Address - Country:US
Practice Address - Phone:918-310-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist