Healthcare Provider Details

I. General information

NPI: 1831297308
Provider Name (Legal Business Name): PATRICK PAUL LITONJUA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 09/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3524 E MILWAUKEE ST
JANESVILLE WI
53546-1626
US

IV. Provider business mailing address

3524 E MILWAUKEE ST
JANESVILLE WI
53546-1626
US

V. Phone/Fax

Practice location:
  • Phone: 608-756-7100
  • Fax: 608-756-4700
Mailing address:
  • Phone: 608-756-7100
  • Fax: 608-756-4700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number52852-020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: