Provider Demographics
NPI:1962618371
Name:SANTIAGO BROWN, NATALIE (MD)
Entity type:Individual
Prefix:DR
First Name:NATALIE
Middle Name:
Last Name:SANTIAGO BROWN
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 1:120 W 111TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628-4215
Mailing Address - Country:US
Mailing Address - Phone:773-768-5000
Mailing Address - Fax:773-821-0312
Practice Address - Street 1:120 W 111TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-4215
Practice Address - Country:US
Practice Address - Phone:773-768-5000
Practice Address - Fax:773-821-0312
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036119553208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036119553Medicaid