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General NPI Number Information
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NPI Number | 1730440470
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Entity Type | Organization
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Legal Business Name | MAXIMO L. CUETO JR. M.D.S.C.
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Dates
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Enumeration Date | 05/30/2012
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Last Update Date | 05/30/2012
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Provider Practice Location Address
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Address Line | 2745 W LAYTON AVE SUITE 102
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City | MILWAUKEE
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State | WI
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Zip | 53221-2651
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Country | US
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Telephone | 414-282-1152
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Fax | 414-282-5485
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Provider Business Mailing Address
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Address Line | 2745 W LAYTON AVE SUITE 102
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City | MILWAUKEE
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State | WI
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Zip | 53221-2651
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Country | US
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Telephone | 414-282-1152
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Fax | 414-282-5485
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MAXIMO LIBRADA CUETO JR.
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Credential | M.D.
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Telephone | 414-282-1152
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 20379-20
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 20379-20
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License Number State | WI
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