Provider Demographics
NPI:1902130032
Name:SANTANGELO, LOUIS DENNIS (DPM)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:DENNIS
Last Name:SANTANGELO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-1918
Mailing Address - Country:US
Mailing Address - Phone:815-933-1633
Mailing Address - Fax:847-933-1728
Practice Address - Street 1:435 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-1918
Practice Address - Country:US
Practice Address - Phone:815-933-1633
Practice Address - Fax:847-933-1728
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-22
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016.005389213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00958793OtherRAILROAD MEDICARE
ILP00945764OtherRAILROAD MEDICARE
ILP00958793OtherRAILROAD MEDICARE
IL201491001Medicare PIN