Healthcare Provider Details

I. General information

NPI: 1952837627
Provider Name (Legal Business Name): ORLANDO FELICIANO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2017
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8701 WATERTOWN PLANK RD
MILWAUKEE WI
53226-3548
US

IV. Provider business mailing address

15135 W LYNWOOD CT
NEW BERLIN WI
53151-2939
US

V. Phone/Fax

Practice location:
  • Phone: 414-805-4400
  • Fax:
Mailing address:
  • Phone: 787-379-6846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number22727
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number100488
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: