MEDICARE: DR. RAYMUNDO MUNOZ VERZOSA 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	2085R0202X	Diagnostic Radiology Physician	25754020	WI

General Provider Information

NPI Number	:	1386727956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAYMUNDO MUNOZ VERZOSA M.D.

Provider Business Mailing Address
First Line	:	2315 HAMILTON ST
Second Line	:
City	:	PORTAGE
State	:	WI
Zip	:	53901-1200
Country	:	US
Telephone Number	:	847-650-9274
Fax Number	:

Provider Business Practice Location Address
First Line	:	2315 HAMILTON ST
Second Line	:
City	:	PORTAGE
State	:	WI
Zip	:	53901-1200
Country	:	US
Telephone Number	:	847-650-9274
Fax Number	:

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

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	07/08/2007

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