Organization Name: | LUIS F. SANTIAGO, M.D., S.C. |
NPI Number: | 1154593051 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | LUIS F SANTIAGO (PRESIDENT) |
Mailing Address: | 5533 W Cermak Rd Cicero |
State: | IL US |
Postal Code: | 608042236 |
Phone Number: | 7087807612 |
Fax Number: | 7087809122 |
NPI Enumeration Date: | 03/31/2008 |
NPI Last Update Date: | 03/31/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |