Healthcare Provider Details

I. General information

NPI: 1194837575
Provider Name (Legal Business Name): KRISTA I SANTOS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6920 PARKDALE PLACE SUITE 109
INDIANAPOLIS IN
46254
US

IV. Provider business mailing address

6920 PARKDALE PLACE SUITE 109
INDIANAPOLIS IN
46254
US

V. Phone/Fax

Practice location:
  • Phone: 317-328-6800
  • Fax: 317-328-6840
Mailing address:
  • Phone: 317-328-6800
  • Fax: 317-328-6840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number01060301
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: