1902901507 NPI number — STEVEN MICHAEL SANTILLI MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902901507 NPI number — STEVEN MICHAEL SANTILLI MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

SANTILLI

Provider First Name:

STEVEN

Provider Middle Name:

MICHAEL

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1902901507

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

07/08/2007

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

UNIVERSITY OF MINNESOTA PHYSICIANS

Provider Second Line Business Mailing Address:

420 DELAWARE STREET SE, MMC 292

Provider Business Mailing Address City Name:

MINNEAPOLIS

Provider Business Mailing Address State Name:

MN

Provider Business Mailing Address Postal Code:

55455

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

612-626-6666

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

516 DELAWARE STREET SE

Provider Second Line Business Practice Location Address:

PWB 1ST FLOOR, CLINIC 1E

Provider Business Practice Location Address City Name:

MINNEAPOLIS

Provider Business Practice Location Address State Name:

MN

Provider Business Practice Location Address Postal Code:

55454

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

612-626-6666

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

09/14/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 208600000X , with the licence number:  30180 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 0056304 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
• Identifier: 37-05671 . This is a "MEDICA PRIMARY" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 515083300 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
• Identifier: 1012217 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 768335 . This is a "ARAZ" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: HP22200 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 37-12619 . This is a "MEDICA CHOICE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 8D479SA . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 030684 . This is a "FAIRVIEW" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 106650 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".