Provider Demographics
NPI:1083647408
Name:SANTILLAN, CONCEPCION ESTEBAN (MD)
Entity Type:Individual
Prefix:DR
First Name:CONCEPCION
Middle Name:ESTEBAN
Last Name:SANTILLAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CONCEPCION
Other - Middle Name:G
Other - Last Name:ESTEBAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:660 MASON RIDGE CENTER DR STE 300
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8512
Mailing Address - Country:US
Mailing Address - Phone:314-448-3791
Mailing Address - Fax:314-996-7658
Practice Address - Street 1:4500 MEMORIAL DR STE 400
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226-5360
Practice Address - Country:US
Practice Address - Phone:618-233-3066
Practice Address - Fax:314-996-7658
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI479162084N0400X
CAC1716422084N0400X
IL0361519442084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34626300Medicaid
WI32837700Medicaid
H34292Medicare UPIN
000007580Medicare ID - Type UnspecifiedGROUP