Provider Demographics
NPI:1497037030
Name:SANTIAGO W CALDERON MD PA
Entity Type:Organization
Organization Name:SANTIAGO W CALDERON MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PREDISENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SANTIAGO
Authorized Official - Middle Name:W
Authorized Official - Last Name:CALDERON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-268-5415
Mailing Address - Street 1:4916 SAN MARINO CIR
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-2608
Mailing Address - Country:US
Mailing Address - Phone:407-268-5415
Mailing Address - Fax:
Practice Address - Street 1:1668 S VOLUSIA AVE
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-7335
Practice Address - Country:US
Practice Address - Phone:386-668-0200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0070874207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBK595AMedicare PIN