MEDICARE: J.A. SANTIESTEBAN, MD, LLC

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	207R00000X	Internal Medicine Physician	MD039877L	PA

General Provider Information

NPI Number	:	1225046535
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	J.A. SANTIESTEBAN, MD, LLC

Provider Business Mailing Address
First Line	:	506 ATHENA DR
Second Line	:
City	:	DELMONT
State	:	PA
Zip	:	15626-1005
Country	:	US
Telephone Number	:	724-468-6869
Fax Number	:	724-468-6207

Provider Business Practice Location Address
First Line	:	3212 MAIN ST
Second Line	:
City	:	MUNHALL
State	:	PA
Zip	:	15120-3230
Country	:	US
Telephone Number	:	412-462-1800
Fax Number	:	412-462-5006

Authorized Official
Title or Position	:	OWNER
Name	:	JOSEPH A SANTIESTEBAN
Credential	:	MD
Telephone Number	:	412-462-1800

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	07/24/2008

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