Healthcare Provider Details

I. General information

NPI: 1568579423
Provider Name (Legal Business Name): KATHLEEN SANTI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 04/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 NORTH CLYDE MORRIS BLVD., SUITE 200 HALIFAX HEALTH MEDICAL CENTER
DAYTONA BEACH FL
32114-2765
US

IV. Provider business mailing address

201 NORTH CLYDE MORRIS BLVD., SUITE 200 HALIFAX HEALTH MEDICAL CENTER
DAYTONA BEACH FL
32114-2765
US

V. Phone/Fax

Practice location:
  • Phone: 386-947-4665
  • Fax: 386-258-4891
Mailing address:
  • Phone: 386-947-4665
  • Fax: 386-258-4891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME14139
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: