Organization
MARIANO L. ROSALES JR., M.D. S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARIANO L ROSALES JR M.D. (PRESIDENT)
(920) 324-3559
Entity
Organization
Contact information
Practice address
600 FERN ST, WAUPUN, WI 53963-1018
(920) 324-3559
(920) 324-0258
Mailing address
600 FERN ST, WAUPUN, WI 53963-1018
(920) 324-3559
(920) 324-0258
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
2190120
WI
261Q00000X
Clinic/Center
Primary
2190620
WI
Other
Enumeration date
10/04/2007
Last updated
10/04/2007
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