| Edgar Santillan Md Llc | |
|
2400 Miami Valley Dr Centerville OH 45459-4774 | |
| (937) 556-4324 | |
| (937) 439-3786 |
| Full Name | Edgar Santillan Md Llc |
|---|---|
| Speciality | Hospitalist |
| Location | 2400 Miami Valley Dr, Centerville, Ohio |
| Authorized Official Name and Position | Edgar R Santillan (OWNER) |
| Authorized Official Contact | 9375564324 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Edgar Santillan Md Llc Po Box 771861 Detroit MI 48277-1861 Ph: (937) 556-4324 | Edgar Santillan Md Llc 2400 Miami Valley Dr Centerville OH 45459-4774 Ph: (937) 556-4324 |
| NPI Number | 1114325321 |
|---|---|
| Provider Enumeration Date | 12/22/2014 |
| Last Update Date | 03/23/2023 |
| Medicare PECOS PAC ID | 5193041614 |
|---|---|
| Medicare Enrollment ID | O20150227001270 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114325321 | NPI | - | NPPES |
| 0117021 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 35075548 (Ohio) | Secondary |
| 208M00000X | Hospitalist | 35075548 (Ohio) | Primary |
| Provider Name | Edgar Roberto Santillan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1902823867 PECOS PAC ID: 6507837044 Enrollment ID: I20040805001335 |
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