Healthcare Provider Details

I. General information

NPI: 1649221516
Provider Name (Legal Business Name): JOAQUIN SOLIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 11/09/2023
Certification Date: 11/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 W KK RIVER PKWY STE 880
MILWAUKEE WI
53215-3678
US

IV. Provider business mailing address

PO BOX 735044
CHICAGO IL
60673-5044
US

V. Phone/Fax

Practice location:
  • Phone: 414-649-3530
  • Fax:
Mailing address:
  • Phone: 414-649-3530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number41485020
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number41485
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: