Provider Demographics
NPI:1114110780
Name:RUBEN E SANTOS, MD, SC
Entity Type:Organization
Organization Name:RUBEN E SANTOS, MD, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:E
Authorized Official - Last Name:SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-664-1470
Mailing Address - Street 1:PO BOX 809059
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60680-9059
Mailing Address - Country:US
Mailing Address - Phone:888-843-8475
Mailing Address - Fax:314-849-6395
Practice Address - Street 1:600 E 1ST ST
Practice Address - Street 2:ST MARGARET'S HOSPITAL
Practice Address - City:SPRING VALLEY
Practice Address - State:IL
Practice Address - Zip Code:61362-1512
Practice Address - Country:US
Practice Address - Phone:815-664-1470
Practice Address - Fax:314-849-6395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-27
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036117681207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1255382230OtherINDIVIDUAL NPI
IL215550OtherMEDICARE GROUP NUMBER
IL14D0431111OtherCLIA
IL0360465101Medicaid
IL1114110780OtherNPI GROUP NUMBER
IL220001540OtherRR MEDICARE
IL215550OtherMEDICARE GROUP NUMBER