Provider Demographics
NPI:1154593051
Name:LUIS F. SANTIAGO, M.D., S.C.
Entity type:Organization
Organization Name:LUIS F. SANTIAGO, M.D., S.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:F
Authorized Official - Last Name:SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-780-7612
Mailing Address - Street 1:PO BOX 3666
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60303-3666
Mailing Address - Country:US
Mailing Address - Phone:708-780-7612
Mailing Address - Fax:708-780-9122
Practice Address - Street 1:5533 W CERMAK RD
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:IL
Practice Address - Zip Code:60804-2236
Practice Address - Country:US
Practice Address - Phone:708-780-7612
Practice Address - Fax:708-780-9122
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LUIS F. SANTIAGO, M.D.,S.C,
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-31
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01618077OtherBLUE CROSS BLUE SHIELD
ILL015046OtherTRICARE
ILL015046OtherTRICARE
IL908060Medicare PIN