Provider Demographics
NPI:1790755759
Name:CALDERON PEREZ, SANTIAGO WILLMAN (MD)
Entity Type:Individual
Prefix:
First Name:SANTIAGO
Middle Name:WILLMAN
Last Name:CALDERON PEREZ
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 1:4916 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:386-775-1175
Mailing Address - Fax:321-256-1547
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:386-775-1175
Practice Address - Fax:321-256-1547
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 70874174400000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL440001648OtherRR MEDICARE
FL000830802OtherHUMANA
FL150170OtherHEALTHEASE
FL251036700Medicaid
FL13935OtherFL MEMORIAL HEALTH NETWOR
FL31616OtherBC/BS
FL150170OtherHEALTHEASE
FLBK596ZMedicare PIN