Healthcare Provider Details

I. General information

NPI: 1962783803
Provider Name (Legal Business Name): LOUIS D SANTANGELO DPM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2011
Last Update Date: 11/29/2011
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 Number016005389
License Number StateIL

VIII. Authorized Official

Name: DR. LOUIS DENNIS SANTANGELO
Title or Position: OWNER
Credential: DPM
Phone: 815-933-1633