Provider Demographics
NPI:1871507236
Name:SANTIAGO, LUIS F (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:F
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:PO BOX 3666
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60303-3666
Mailing Address - Country:US
Mailing Address - Phone:708-780-7612
Mailing Address - Fax:708-780-9122
Practice Address - Street 1:5533 W CERMAK RD
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:IL
Practice Address - Zip Code:60804-2236
Practice Address - Country:US
Practice Address - Phone:708-780-7612
Practice Address - Fax:708-780-9122
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208000000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL015046OtherTRICARE
IL01618077OtherBCBS PPO
IL01618077OtherBCBS PPO
E19360Medicare UPIN