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NPI Code Detail

MEDICARE: MR. IAN MICHAEL SANTUS BCBA

MEDICARE: MR. IAN MICHAEL SANTUS BCBA
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
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1699065458
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. IAN MICHAEL SANTUS BCBA
Provider Business Mailing Address
First Line : 1607 WHITE PINE WAY
Second Line :
City : OXFORD
State : MI
Zip : 48371-1216
Country : US
Telephone Number : 616-446-1047
Fax Number :
Provider Business Practice Location Address
First Line : 132 ROBBS HILL RD
Second Line :
City : LUNENBURG
State : MA
Zip : 01462-2167
Country : US
Telephone Number : 774-270-1766
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/13/2011
Last Update Date : 07/26/2021

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