Individual
JOSE MANUEL CARRILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1102 S PARK ST, MADISON, WI 53715-1708
(608) 263-3111
(608) 263-6663
Mailing address
7974 UW HEALTH CT, MIDDLETON, WI 53562-5531
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
77865-20
WI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/21/2021
Last updated
08/09/2024
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