Provider Demographics
NPI:1376523282
Name:SANTANGELO, MEGAN M (MD)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:M
Last Name:SANTANGELO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7917 MACKINAW TRL
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-9746
Mailing Address - Country:US
Mailing Address - Phone:231-779-9700
Mailing Address - Fax:231-779-9765
Practice Address - Street 1:7917 MACKINAW TRL
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-9746
Practice Address - Country:US
Practice Address - Phone:231-779-9700
Practice Address - Fax:231-779-9765
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35077322208000000X
MI4301099534208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2232346Medicaid
OHH52438Medicare UPIN
OH2232346Medicaid