Healthcare Provider Details

I. General information

NPI: 1902130032
Provider Name (Legal Business Name): LOUIS DENNIS SANTANGELO D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2009
Last Update Date: 05/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 S MAIN ST
BOURBONNAIS IL
60914-1918
US

IV. Provider business mailing address

435 S MAIN ST
BOURBONNAIS IL
60914-1918
US

V. Phone/Fax

Practice location:
  • Phone: 815-933-1633
  • Fax: 847-933-1728
Mailing address:
  • Phone: 815-933-1633
  • Fax: 847-933-1728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number016.005389
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: