Provider Demographics
NPI:1306862735
Name:SANTAELLA, ROBERT OSCAR (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:OSCAR
Last Name:SANTAELLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6898 LEBANON RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034
Mailing Address - Country:US
Mailing Address - Phone:972-335-7874
Mailing Address - Fax:214-407-8249
Practice Address - Street 1:6898 LEBANON RD
Practice Address - Street 2:SUITE 103
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034
Practice Address - Country:US
Practice Address - Phone:972-335-7874
Practice Address - Fax:214-407-8249
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9633208600000X, 2086S0129X, 208600000X
IL0361152812086S0129X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK25565Medicare UPIN