Individual
KEITH JOHN SANTIAGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2880 TRICOM ST, NORTH CHARLESTON, SC 29406-9171
(843) 797-5050
(843) 797-3633
Mailing address
2880 TRICOM ST, NORTH CHARLESTON, SC 29406-9171
(843) 797-5050
(843) 797-3633
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
32526
SC
207XS0106X
Orthopaedic Hand Surgery Physician
Primary
32526
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1326287434
MEDICAID DME NPI
SC
01
—
20076508
SELECT HEALTH DME
SC
01
—
32526
CURRENT STATE MEDICAL LICENSE
SC
05
—
325269
—
SC
01
—
D043
MEDICARE GROUP PTAN
SC
01
—
DU4331
RAILROAD MEDICARE GROUP PTAN
SC
01
—
GP6337
MEDICAID GROUP
SC
01
—
P01283675
RAILROAD MEDICARE PTAN
SC
Enumeration date
08/19/2008
Last updated
03/12/2020
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