Individual
MARIA ROSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
20 S PARK ST, MADISON, WI 53715-1348
(608) 287-2580
Mailing address
7974 UW HEALTH CT, MIDDLETON, WI 53562-5531
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
036105978
IL
208000000X
Pediatrics Physician
Primary
72674
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
IL2613
MEDICARE GROUP PTAN
IL
Enumeration date
09/21/2006
Last updated
12/20/2022
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