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NPI Code Detail

MEDICARE: DR. PEDRO M. BANDA MD

MEDICARE: DR. PEDRO M. BANDA MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208800000XUrology Physician45820WI

General Provider Information

NPI Number : 1033106877
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PEDRO M. BANDA MD
Provider Business Mailing Address
First Line : 4425 N PORT WASHINGTON RD
Second Line : ATTN: CSMCP CLINIC CREDENTIALING
City : GLENDALE
State : WI
Zip : 53212-1082
Country : US
Telephone Number : 414-319-3000
Fax Number :
Provider Business Practice Location Address
First Line : 2311 N PROSPECT AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53211-4445
Country : US
Telephone Number : 414-319-3000
Fax Number : 414-319-3087
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/05/2005
Last Update Date : 06/07/2012

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