Provider Demographics
NPI:1922197649
Name:SANTANGELO, LOUIS M (DPM)
Entity type:Individual
Prefix:
First Name:LOUIS
Middle Name:M
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 1:8145 N MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-2828
Mailing Address - Country:US
Mailing Address - Phone:847-470-0555
Mailing Address - Fax:847-470-0019
Practice Address - Street 1:8145 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-2828
Practice Address - Country:US
Practice Address - Phone:847-470-0555
Practice Address - Fax:847-470-0019
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016003075213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016003075Medicaid
IL01632760OtherBCBS
ILP00005546OtherRAILROAD MEDICARE
IL01632760OtherBCBS
ILK08554Medicare PIN
ILT37643Medicare UPIN