Individual
DR. SOLIVEN C BAUTISTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
201 N MAYFAIR RD FL 4, WAUWATOSA, WI 53226-4216
(414) 259-7246
(414) 259-7544
Mailing address
3106 WEDGEWOOD DR, COLGATE, WI 53017-9570
(414) 732-1503
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
44156-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
045873840
MEDICARE PTAN
WI
Enumeration date
07/08/2005
Last updated
01/07/2025
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