MEDICARE: ANTHONY J SANTIAGO 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	2084N0400X	Neurology Physician	43209	AZ

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	:	1912990060
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY J SANTIAGO MD

Provider Business Mailing Address
First Line	:	720 WASHINGTON AVE SE
Second Line	:	SUITE 300
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55414-2924
Country	:	US
Telephone Number	:	612-626-6688
Fax Number	:	612-626-3217

Provider Business Practice Location Address
First Line	:	516 DELAWARE ST SE
Second Line	:	CLINIC 1A
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55455-0356
Country	:	US
Telephone Number	:	612-626-6688
Fax Number	:	612-626-3217

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

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	06/12/2014

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