MEDICARE: ARTHUR CRISOSTOMO 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	207RP1001X	Pulmonary Disease Physician	28637	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	:	1609849140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARTHUR CRISOSTOMO M.D.

Provider Business Mailing Address
First Line	:	N57W42950 N CORPORATE CIRCLE
Second Line	:	PROHEALTH CARE MEDICAL ASSOCIATES INC.
City	:	SUSSEX
State	:	WI
Zip	:	53089-4383
Country	:	US
Telephone Number	:	262-820-3093
Fax Number	:	262-532-9598

Provider Business Practice Location Address
First Line	:	N57W24950 N CORPORATE CIR
Second Line	:	PROHEALTH CARE MEDICAL ASSOCIATES INC.
City	:	SUSSEX
State	:	WI
Zip	:	53089-4383
Country	:	US
Telephone Number	:	262-820-3093
Fax Number	:	262-532-9598

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

Provider Enumeration Date	:	02/07/2006
Last Update Date	:	11/23/2011

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53089-4383

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Practice Fax: 262-532-9598

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