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General NPI Number Information
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NPI Number | 1467757948
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Entity Type | Individual
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Provider Name | KAREN RONQUILLO M.S., M.D.
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Gender | Female
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Dates
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Enumeration Date | 01/14/2011
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 20611 WATERTOWN RD STE C
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City | WAUKESHA
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State | WI
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Zip | 53186-1871
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Country | US
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Telephone | 262-333-3173
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Fax | 262-333-3173
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Provider Business Mailing Address
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Address Line | 300 E BROADWAY
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City | WAUKESHA
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State | WI
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Zip | 53187-3001
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Country | US
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Telephone | 414-708-8852
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Fax | 262-364-3099
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083C0008X
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Taxonomy Name | Clinical Informatics Physician
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License Number | 55146-20
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | ACN 378
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 55146-020
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License Number State | WI
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Taxonomy #4
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Taxonomy Code | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number | 55146-20
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License Number State | WI
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