MEDICARE: LATA SANTA INES 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	207V00000X	Obstetrics & Gynecology Physician	49654	WI
2	207V00000X	Obstetrics & Gynecology Physician	8671780	ID
3	207V00000X	Obstetrics & Gynecology Physician	ME151048	FL

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871621136
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATA SANTA INES MD

Provider Business Mailing Address
First Line	:	3351 SANDSTONE CT
Second Line	:
City	:	LAKE IN THE HILLS
State	:	IL
Zip	:	60156-4425
Country	:	US
Telephone Number	:	224-231-7335
Fax Number	:

Provider Business Practice Location Address
First Line	:	373 SUMMIT ST
Second Line	:	SUITE 105
City	:	ELGIN
State	:	IL
Zip	:	60120
Country	:	US
Telephone Number	:	847-888-3631
Fax Number	:

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

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	12/11/2025

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Directions to “ LATA SANTA INES MD” Practice Location

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