Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 036-107524 | IL |
NPI | 1295743953 |
---|---|
Provider Name | Juan Santiago-Palma |
First Address | Bradley, IL 60915 |
Second Address | Bradley, IL 60915 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2006 |
Last Update Date | 06/04/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
36107524 | (05) | IL |
I27083 | (02) | IL |