Individual
DR. KENNETH A SANTIAGO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9021 BELLA VERDE CT, MYRTLE BEACH, SC 29579-5110
(843) 516-2024
Mailing address
PO BOX 70157, MYRTLE BEACH, SC 29572-0021
(843) 516-2024
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
212611
MA
207R00000X
Internal Medicine Physician
Primary
34596
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2098075
—
MA
05
—
345969
—
SC
01
—
7844
MEDIARE GROUP PTAN
SC
05
—
GP4505
—
SC
Enumeration date
11/14/2005
Last updated
02/25/2021
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