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1518963347

NPI Code Detail

MEDICARE: DR. IVAN L MALDONADO M.D.

MEDICARE: DR. IVAN L MALDONADO 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	208600000X	Surgery Physician	55941	WI
2	208600000X	Surgery Physician	59285	NJ
3	2086S0102X	Surgical Critical Care Physician	59285	NJ
4	2086S0127X	Trauma Surgery Physician	55941	WI
5	2086S0127X	Trauma Surgery Physician	59285	NJ
6	2086S0102X	Surgical Critical Care Physician	55941	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	:	1518963347
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IVAN L MALDONADO M.D.

Provider Business Mailing Address
First Line	:	1000 N OAK AVE
Second Line	:
City	:	MARSHFIELD
State	:	WI
Zip	:	54449-5703
Country	:	US
Telephone Number	:	715-387-5511
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 N OAK AVE
Second Line	:
City	:	MARSHFIELD
State	:	WI
Zip	:	54449-5703
Country	:	US
Telephone Number	:	715-387-5511
Fax Number	:

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

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	11/17/2022

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Directions to “ DR. IVAN L MALDONADO M.D.” Practice Location

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