Provider Demographics
NPI:1801834445
Name:SANTIAGO-AGOSTINI, ANTONIO (MD)
Entity type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:
Last Name:SANTIAGO-AGOSTINI
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 1:300 HEALTH PARK DR STE 302
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-1293
Mailing Address - Country:US
Mailing Address - Phone:989-723-5540
Mailing Address - Fax:989-720-2292
Practice Address - Street 1:300 HEALTH PARK DR STE 302
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-1293
Practice Address - Country:US
Practice Address - Phone:989-723-5540
Practice Address - Fax:989-720-2292
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301054955207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1801834445Medicaid
MI0400022OtherPHP
MI4629349OtherAETNA
MI1107801002OtherBC/BS
MIP59341OtherBCN
MI1107801002OtherBC/BS
MI4629349OtherAETNA