Provider Demographics
NPI:1902010903
Name:SANTOS, ERIC EUGENE (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:EUGENE
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 809059
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60680-9059
Mailing Address - Country:US
Mailing Address - Phone:888-843-8475
Mailing Address - Fax:314-849-6395
Practice Address - Street 1:600 E 1ST ST
Practice Address - Street 2:ST MARGARET'S HOSPITAL/DEPARTMENT OF PATHOLOGY
Practice Address - City:SPRING VALLEY
Practice Address - State:IL
Practice Address - Zip Code:61362-1512
Practice Address - Country:US
Practice Address - Phone:815-664-1470
Practice Address - Fax:815-664-1141
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.117681207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL14D0431111OtherCLIA
IL036.117681OtherIL STATE LICENSE NUMBER
IL215550OtherMEDICARE GROUP NUMBER
IL1114110780OtherGROUP NPI
IL615604OtherBSCHI
ILK44375Medicare PIN