Healthcare Provider Details

I. General information

NPI: 1386640811
Provider Name (Legal Business Name): MOISES A GARCIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MOISES ANTONIO GARCIA-BONILLA M.D.

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 W OKLAHOMA AVE 5TH FL
MILWAUKEE WI
53215-4330
US

IV. Provider business mailing address

PO BOX 735044
CHICAGO IL
60673-5044
US

V. Phone/Fax

Practice location:
  • Phone: 414-646-0548
  • Fax:
Mailing address:
  • Phone: 800-326-2250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RT0003X
TaxonomyTransplant Hepatology Physician
License Number45215
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207RI0008X
TaxonomyHepatology Physician
License Number45215
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number45215
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: