MEDICARE: JOSEPH PUCCINELLI M.D.

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
1	207X00000X	Orthopaedic Surgery Physician	33107	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134125842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH PUCCINELLI M.D.

Provider Business Mailing Address
First Line	:	7545 N PORT WASHINGTON RD
Second Line	:
City	:	GLENDALE
State	:	WI
Zip	:	53217-3422
Country	:	US
Telephone Number	:	414-351-3500
Fax Number	:	414-351-9063

Provider Business Practice Location Address
First Line	:	7545 N PORT WASHINGTON RD
Second Line	:
City	:	GLENDALE
State	:	WI
Zip	:	53217-3422
Country	:	US
Telephone Number	:	414-351-3500
Fax Number	:	414-351-9063

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	11/16/2022

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