Healthcare Provider Details

I. General information

NPI: 1992982573
Provider Name (Legal Business Name): IRENE VALERIO M.D., RCEP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: IRENE VALERIO-VARGAS MD

II. Dates (important events)

Enumeration Date: 01/26/2008
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10400 75TH ST
KENOSHA WI
53142
US

IV. Provider business mailing address

PO BOX 735044
CHICAGO IL
60673-5044
US

V. Phone/Fax

Practice location:
  • Phone: 262-948-5600
  • Fax: 262-948-5735
Mailing address:
  • Phone: 800-326-2250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Y00000X
TaxonomyClinical Exercise Physiologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number71261
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: