Provider Demographics
NPI:1720121213
Name:SANTIAGO, ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
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 1:247 GLEN VILLAGE CT
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-9677
Mailing Address - Country:US
Mailing Address - Phone:614-431-8869
Mailing Address - Fax:614-431-9910
Practice Address - Street 1:396 PORTLAND WAY N
Practice Address - Street 2:
Practice Address - City:GALION
Practice Address - State:OH
Practice Address - Zip Code:44833-1115
Practice Address - Country:US
Practice Address - Phone:419-462-5543
Practice Address - Fax:419-462-2058
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-05-7517208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1076649OtherWORKER'S COMP EMPL. RISK
OH0759362Medicaid
OH35-05-7517OtherOHIO MEDICAL LICENSE
OH35-05-7517OtherOHIO MEDICAL LICENSE
OHBS165421OtherFEDERAL DEA NUMBER
OH34-1898893OtherTIN
OH0759362Medicaid