MEDICARE: DR. SERGIO CRUZ CASACLANG 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	37206	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	:	1871502906
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SERGIO CRUZ CASACLANG MD

Provider Business Mailing Address
First Line	:	2727 W CLEVELAND AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53215-2956
Country	:	US
Telephone Number	:	414-384-5420
Fax Number	:	414-384-0134

Provider Business Practice Location Address
First Line	:	2727 W CLEVELAND AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53215-2956
Country	:	US
Telephone Number	:	414-384-5420
Fax Number	:	414-384-0134

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

Provider Enumeration Date	:	08/07/2006
Last Update Date	:	03/07/2023

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Directions to “ DR. SERGIO CRUZ CASACLANG MD” Practice Location

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