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General NPI Number Information
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NPI Number | 1720057771
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Entity Type | Individual
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Provider Name | EDGARDO C JIONGCO MD
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Gender | Male
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Dates
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Enumeration Date | 03/14/2006
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Last Update Date | 02/18/2008
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Provider Practice Location Address
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Address Line | 601 HANDEYSIDE LANE
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City | FORT ATKINSON
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State | WI
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Zip | 53538
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Country | US
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Telephone | 920-563-5544
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Fax | 608-833-6932
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Provider Business Mailing Address
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Address Line | 8007 EXCELSIOR DRIVE
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City | MADISON
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State | WI
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Zip | 53717
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Country | US
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Telephone | 608-829-5238
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Fax | 608-833-6932
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 20514
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License Number State | WI
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