Provider Demographics
NPI:1366739674
Name:SANTIAGO-ROSADO, LUIS ANTONIO (MD)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:ANTONIO
Last Name:SANTIAGO-ROSADO
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 1:37 PALMER ST STE 1A
Mailing Address - Street 2:
Mailing Address - City:CALAIS
Mailing Address - State:ME
Mailing Address - Zip Code:04619-1341
Mailing Address - Country:US
Mailing Address - Phone:207-454-8432
Mailing Address - Fax:207-454-3616
Practice Address - Street 1:37 PALMER ST STE 1A
Practice Address - Street 2:
Practice Address - City:CALAIS
Practice Address - State:ME
Practice Address - Zip Code:04619-1341
Practice Address - Country:US
Practice Address - Phone:207-454-8432
Practice Address - Fax:207-454-3616
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-07
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD25056208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty