Provider Demographics
NPI:1114968476
Name:SANTIAGO, LYRIC L (MD)
Entity type:Individual
Prefix:
First Name:LYRIC
Middle Name:L
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 PUUHONU PL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720
Mailing Address - Country:US
Mailing Address - Phone:808-969-1000
Mailing Address - Fax:808-969-1020
Practice Address - Street 1:75 PUUHONU PL
Practice Address - Street 2:SUITE 100
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720
Practice Address - Country:US
Practice Address - Phone:808-969-1000
Practice Address - Fax:808-969-1020
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD - 11906174400000X
HIMD11906208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
H15673Medicare UPIN
HIH103107Medicare PIN