Healthcare Provider Details

I. General information

NPI: 1861414872
Provider Name (Legal Business Name): KERRI BARDELL SANTIAGO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 02/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UMC PATHOLOGY 2390 W CONGRESS ST
LAFAYETTE LA
70506
US

IV. Provider business mailing address

1340 POYDRAS ST
NEW ORLEANS LA
70112-1221
US

V. Phone/Fax

Practice location:
  • Phone: 337-261-6212
  • Fax:
Mailing address:
  • Phone: 504-412-1860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number09917R
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License NumberMD.09917R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: