MEDICARE: GEORGE A IDARRAGA 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
1	208000000X	Pediatrics Physician	39892	WI
2	208000000X	Pediatrics Physician	39892-20	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	:	1487699674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE A IDARRAGA MD

Provider Business Mailing Address
First Line	:	202 S PARK ST
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53715-1507
Country	:	US
Telephone Number	:	608-417-6000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1432 W FOREST HOME AVE STE 200
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53204-3228
Country	:	US
Telephone Number	:	414-567-5401
Fax Number	:	414-567-5358

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

Provider Enumeration Date	:	06/19/2006
Last Update Date	:	11/18/2025

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Directions to “ GEORGE A IDARRAGA MD” Practice Location

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