Provider Demographics
NPI:1457565566
Name:CHAHWAN, SANTIAGO H (MD)
Entity Type:Individual
Prefix:DR
First Name:SANTIAGO
Middle Name:H
Last Name:CHAHWAN
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 1:2450 GOODLETTE RD N
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34103-4595
Mailing Address - Country:US
Mailing Address - Phone:239-643-8794
Mailing Address - Fax:239-430-7820
Practice Address - Street 1:2450 GOODLETTE RD N
Practice Address - Street 2:SUITE 102
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-4595
Practice Address - Country:US
Practice Address - Phone:239-643-8794
Practice Address - Fax:239-430-7820
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME986092086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME98609OtherSTATE LICENSE
FL96302OtherBC/BS PROVIDER#
FL278222700Medicaid
FLAE033ZMedicare PIN