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General NPI Number Information
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NPI Number | 1962783803
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Entity Type | Organization
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Legal Business Name | LOUIS D SANTANGELO DPM PC
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Dates
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Enumeration Date | 09/06/2011
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Last Update Date | 11/29/2011
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Provider Practice Location Address
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Address Line | 435 S MAIN ST
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City | BOURBONNAIS
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State | IL
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Zip | 60914-1918
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Country | US
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Telephone | 815-933-1633
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Fax | 847-933-1728
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Provider Business Mailing Address
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Address Line | 435 S MAIN ST
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City | BOURBONNAIS
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State | IL
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Zip | 60914-1918
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Country | US
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Telephone | 815-933-1633
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Fax | 847-933-1728
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Authorized Official
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Title or Position | OWNER
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Name | DR. LOUIS DENNIS SANTANGELO
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Credential | DPM
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Telephone | 815-933-1633
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 016005389
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License Number State | IL
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