Provider Demographics
NPI:1194764217
Name:SANTANA, MARCUS G (MD)
Entity type:Individual
Prefix:
First Name:MARCUS
Middle Name:G
Last Name:SANTANA
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:PO BOX 4100
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04243-4100
Mailing Address - Country:US
Mailing Address - Phone:207-795-2237
Mailing Address - Fax:
Practice Address - Street 1:100 NW 170TH ST STE 301
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33169-5511
Practice Address - Country:US
Practice Address - Phone:305-651-3038
Practice Address - Fax:305-655-1153
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD24078207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI60454OtherDEAN HEALTH INSURANCE
WI34709300Medicaid
WI095574150Medicare PIN
WI34709300Medicaid
WI038154340Medicare PIN
WIP00298102Medicare PIN