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NPI Code Detail

MEDICARE: DR. IVETTE SANTIAGO-MARTIR M.D.

MEDICARE: DR. IVETTE SANTIAGO-MARTIR M.D.
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
1207Q00000XFamily Medicine PhysicianME65818FL
2207Q00000XFamily Medicine Physician101957WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2ME65818OTHERFLMEDICAL LICENSE
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1316966708
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. IVETTE SANTIAGO-MARTIR M.D.
Provider Business Mailing Address
First Line : 4614 E MICHIGAN ST
Second Line :
City : ORLANDO
State : FL
Zip : 32812-5233
Country : US
Telephone Number : 407-720-3780
Fax Number : 407-720-3781
Provider Business Practice Location Address
First Line : 4614 E MICHIGAN ST
Second Line :
City : ORLANDO
State : FL
Zip : 32812-5233
Country : US
Telephone Number : 407-720-3780
Fax Number : 407-720-3781
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/18/2006
Last Update Date : 06/11/2026

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