Provider Demographics
NPI:1083930853
Name:SANTELLE, KARA MELINDA
Entity Type:Individual
Prefix:MRS
First Name:KARA
Middle Name:MELINDA
Last Name:SANTELLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5333 MEADOWLARK ST NW
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-6816
Mailing Address - Country:US
Mailing Address - Phone:330-494-3976
Mailing Address - Fax:
Practice Address - Street 1:2322 44TH ST NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44709-2126
Practice Address - Country:US
Practice Address - Phone:330-493-9204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-19
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRP077062172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3005769Medicaid