Individual
TADEO A DIAZ BALDERRAMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
420 E DIVISION ST, FOND DU LAC, WI 54935-4560
(920) 926-8230
(920) 926-8997
Mailing address
420 E DIVISION ST, FOND DU LAC, WI 54935-4560
(920) 926-8230
(920) 926-8997
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
59901
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1437458817
—
WI
Enumeration date
03/24/2011
Last updated
12/30/2024
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