Provider Demographics
NPI:1588663876
Name:SANTOS, RENE E (MD)
Entity Type:Individual
Prefix:DR
First Name:RENE
Middle Name:E
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 1:4647 LINCOLN HWY
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-2319
Mailing Address - Country:US
Mailing Address - Phone:708-747-5850
Mailing Address - Fax:708-747-9991
Practice Address - Street 1:71 W 156TH ST
Practice Address - Street 2:SUITE 305
Practice Address - City:HARVEY
Practice Address - State:IL
Practice Address - Zip Code:60426-4260
Practice Address - Country:US
Practice Address - Phone:708-333-3113
Practice Address - Fax:708-333-8991
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036070775207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036070775Medicaid
IL3160176976OtherBLUE SHIELD
911220Medicare PIN
ILCM7411Medicare PIN
ILL05024Medicare PIN
ILL81232Medicare PIN
594180Medicare PIN
IL3160176976OtherBLUE SHIELD
IL036070775Medicaid
IL440003100Medicare PIN