MEDICARE: PEDRO O RANOLA 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	207Q00000X	Family Medicine Physician	21444	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	:	1629167887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PEDRO O RANOLA MD

Provider Business Mailing Address
First Line	:	4555 W SCHROEDER DR
Second Line	:	#170
City	:	MILWAUKEE
State	:	WI
Zip	:	53223-1475
Country	:	US
Telephone Number	:	414-365-3210
Fax Number	:	414-365-3225

Provider Business Practice Location Address
First Line	:	1919 W NORTH AVE
Second Line	:	#200
City	:	MILWAUKEE
State	:	WI
Zip	:	53205-1153
Country	:	US
Telephone Number	:	414-287-1000
Fax Number	:	414-287-1010

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

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	10/11/2011

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