Organization
OBSTETRICS AND GYNECOLOGY CARE ASSOCIATES, S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SANTIAGO JOSEPH M.D. (OWNER)
(309) 662-2273
Entity
Organization
Contact information
Practice address
1414 WOODBINE RD, BLOOMINGTON, IL 61704-2817
(309) 662-2273
(309) 662-2014
Mailing address
1414 WOODBINE RD, BLOOMINGTON, IL 61704-2817
(309) 662-2273
(309) 662-2014
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
207V000000X
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
193400000X
TAXONOMY
IL
01
—
CK6294
RAILROAD MEDICARE
—
Enumeration date
10/02/2006
Last updated
04/11/2018
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