Individual
NELSON AGUSTIN RODRIGUEZ UNDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1155 N MAYFAIR RD STE T2600, WAUWATOSA, WI 53226-3464
(414) 955-1000
(414) 955-0183
Mailing address
1155 N MAYFAIR RD STE T2600, WAUWATOSA, WI 53226-3464
(414) 955-1000
(414) 955-0183
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
76481
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1346620010
—
WI
Enumeration date
06/08/2015
Last updated
07/14/2022
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