Provider Demographics
NPI:1598792483
Name:SANTIAGO, ANGELO M (MD,)
Entity Type:Individual
Prefix:DR
First Name:ANGELO
Middle Name:M
Last Name:SANTIAGO
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 1:5820 EAST 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609
Mailing Address - Country:US
Mailing Address - Phone:307-234-9037
Mailing Address - Fax:307-234-9042
Practice Address - Street 1:5820 EAST 2ND ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609
Practice Address - Country:US
Practice Address - Phone:307-234-9037
Practice Address - Fax:307-234-9042
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY5622A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY313140OtherBCBS
WY115004900Medicaid
WYP00152272OtherRAILROAD MEDICARE
WY313140OtherBCBS
WYGO8117Medicare UPIN