MEDICARE: EDGAR R SANTILLAN 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
1	208M00000X	Hospitalist Physician	35.075548	OH
2	207R00000X	Internal Medicine Physician	35-075548	OH

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	:	1902823867
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDGAR R SANTILLAN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 771861
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48277-1861
Country	:	US
Telephone Number	:	937-556-4324
Fax Number	:	937-350-6477

Provider Business Practice Location Address
First Line	:	2400 MIAMI VALLEY DR
Second Line	:
City	:	CENTERVILLE
State	:	OH
Zip	:	45459-4774
Country	:	US
Telephone Number	:	937-556-4324
Fax Number	:	937-439-3786

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

Provider Enumeration Date	:	07/16/2006
Last Update Date	:	03/23/2023

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