Provider Demographics
NPI:1053351353
Name:DELOS SANTOS, MIGDONIA M (MD)
Entity type:Individual
Prefix:DR
First Name:MIGDONIA
Middle Name:M
Last Name:DELOS SANTOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MIGDONIA
Other - Middle Name:M
Other - Last Name:DELOS SANTOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:P.O. BOX 7336
Mailing Address - Street 2:
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154
Mailing Address - Country:US
Mailing Address - Phone:773-488-8100
Mailing Address - Fax:
Practice Address - Street 1:2024 W. 79TH STREET
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60620
Practice Address - Country:US
Practice Address - Phone:773-488-8100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36-056060207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine