Provider Demographics
NPI:1194837575
Name:SANTOS, KRISTA I (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTA
Middle Name:I
Last Name:SANTOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6920 PARKDALE PLACE
Mailing Address - Street 2:SUITE 109
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254
Mailing Address - Country:US
Mailing Address - Phone:317-328-6800
Mailing Address - Fax:317-328-6840
Practice Address - Street 1:6920 PARKDALE PLACE
Practice Address - Street 2:SUITE 109
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254
Practice Address - Country:US
Practice Address - Phone:317-328-6800
Practice Address - Fax:317-328-6840
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN010603012080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000364651OtherANTHEM
5628778OtherFIRST HEALTH
6185773002OtherCIGNA