Individual
MIGUEL A JIMENEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1969 W HART RD, BELOIT, WI 53511
(608) 364-5269
Mailing address
2101 RIVERSIDE DR, BELOIT, WI 53511
(608) 362-7888
(608) 362-8470
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
26724020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0360495311
ILLINOIS PUBLIC AID
WI
05
—
30636900
—
WI
Enumeration date
07/18/2006
Last updated
07/08/2007
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