Healthcare Provider Details

I. General information

NPI: 1639139744
Provider Name (Legal Business Name): JAVIER A RINCON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 09/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 S 70TH ST
WEST ALLIS WI
53214-3147
US

IV. Provider business mailing address

PO BOX 1440 ATTN: CLINIC CREDENTIALING
WAUTOMA WI
54982-1440
US

V. Phone/Fax

Practice location:
  • Phone: 414-773-6600
  • Fax: 414-773-6656
Mailing address:
  • Phone: 920-787-5514
  • Fax: 920-787-4737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number29828
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: