Healthcare Provider Details

I. General information

NPI: 1053370809
Provider Name (Legal Business Name): SALVADOR V. DEL ROSARIO,M.D., S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 06/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N54W6135 MILL ST SUITE 600
CEDARBURG WI
53012-2021
US

IV. Provider business mailing address

PO BOX 72018
CEDARBURG WI
53012-7218
US

V. Phone/Fax

Practice location:
  • Phone: 262-375-1130
  • Fax: 262-375-7006
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20277
License Number StateWI

VIII. Authorized Official

Name: DR. SALVADOR VELOSO DEL ROSARIO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 262-375-1130