Provider Demographics
NPI:1568530806
Name:SANTOS, VENERIO MELENDRES (MD)
Entity Type:Individual
Prefix:DR
First Name:VENERIO
Middle Name:MELENDRES
Last Name:SANTOS
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 1:12746 ROLLING HILLS DR
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:IL
Mailing Address - Zip Code:62293
Mailing Address - Country:US
Mailing Address - Phone:618-224-9834
Mailing Address - Fax:
Practice Address - Street 1:9330 SHATTUC RD
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:IL
Practice Address - Zip Code:62801
Practice Address - Country:US
Practice Address - Phone:618-533-4111
Practice Address - Fax:618-533-0370
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL744151Medicare ID - Type Unspecified