Individual
JONNY ALEXANDER MACIAS TEJADA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2900 W OKLAHOMA AVE, MILWAUKEE, WI 53215-4330
(414) 649-6000
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
52098-020
WI
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
52098-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100005725
—
WI
Enumeration date
05/21/2007
Last updated
09/24/2024
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