Provider Demographics
NPI:1316080682
Name:SANTIAGO, STEVEN (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
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 1:3510 BISCAYNE BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-3840
Mailing Address - Country:US
Mailing Address - Phone:305-576-1234
Mailing Address - Fax:305-571-2025
Practice Address - Street 1:3510 BISCAYNE BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-3840
Practice Address - Country:US
Practice Address - Phone:305-576-1234
Practice Address - Fax:305-571-2025
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0066248207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL251270000Medicaid
FL26341Medicare ID - Type Unspecified
FLF67289Medicare UPIN