MEDICARE: SANTIAGO R. MACIAS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD2004-0045	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154328094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANTIAGO R. MACIAS MD

Provider Business Mailing Address
First Line	:	PO BOX 26666
Second Line	:	PHS PROVIDER ENROLLMENT
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87125-6666
Country	:	US
Telephone Number	:	505-923-6770
Fax Number	:	505-923-5354

Provider Business Practice Location Address
First Line	:	2001 EL CENTRO FAMILIAR BLVD SW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87105-4592
Country	:	US
Telephone Number	:	505-873-7400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	05/07/2018

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