Individual
MR. DEOGRACIAS R ESTRADA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
800 RIVERSIDE DR, WAUPACA, WI 54981-1943
(715) 258-1000
Mailing address
3 NEENAH CTR, NEENAH, WI 54956-3070
(715) 258-1000
(715) 256-2097
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
42053
WI
208M00000X
Hospitalist Physician
Primary
42053
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32641900
—
WI
Enumeration date
07/11/2006
Last updated
11/10/2021
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