Provider Demographics
NPI:1184940322
Name:PAUL SANTANGELO, DPM, PC
Entity type:Organization
Organization Name:PAUL SANTANGELO, DPM, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTANGELO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:630-493-0600
Mailing Address - Street 1:8145 N MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-2828
Mailing Address - Country:US
Mailing Address - Phone:847-470-0555
Mailing Address - Fax:847-470-0019
Practice Address - Street 1:6442 S CASS AVE
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-3209
Practice Address - Country:US
Practice Address - Phone:630-493-0600
Practice Address - Fax:630-493-0686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-13
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016004366213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1632760OtherBCBS
IL1632760OtherBCBS
IL209487Medicare PIN