Provider Demographics
NPI:1144216185
Name:SANTIAGO, JULIO A (MD)
Entity type:Individual
Prefix:DR
First Name:JULIO
Middle Name:A
Last Name:SANTIAGO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9727
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61612-9727
Mailing Address - Country:US
Mailing Address - Phone:309-886-9172
Mailing Address - Fax:
Practice Address - Street 1:256 S SOANGETAHA RD
Practice Address - Street 2:
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401-5586
Practice Address - Country:US
Practice Address - Phone:309-233-2836
Practice Address - Fax:888-464-1233
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036093955207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0006632002OtherBLUE CROSS OF IL
IL371352599001Medicaid
IL366007544007Medicaid
IL366007544007Medicaid
ILL88524Medicare Oscar/Certification
IL0006632002OtherBLUE CROSS OF IL