Provider Demographics
NPI:1588609002
Name:SANTOS, JOAQUIN G (MD)
Entity Type:Individual
Prefix:
First Name:JOAQUIN
Middle Name:G
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:PO BOX 8035
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-0035
Mailing Address - Country:US
Mailing Address - Phone:316-689-9135
Mailing Address - Fax:316-689-9102
Practice Address - Street 1:818 N CARRIAGE PKWY
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-4511
Practice Address - Country:US
Practice Address - Phone:316-651-2252
Practice Address - Fax:316-651-2314
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS20499207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100001OtherHPK
KS11084871OtherMULTIPLAN
KS4418OtherPHS
KS17017OtherCOVENTRY
KS0599906OtherBCBS
KS0599906OtherBCBS
B68801Medicare UPIN