Provider Demographics
NPI:1053370809
Name:SALVADOR V. DEL ROSARIO,M.D., S.C.
Entity type:Organization
Organization Name:SALVADOR V. DEL ROSARIO,M.D., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SALVADOR
Authorized Official - Middle Name:VELOSO
Authorized Official - Last Name:DEL ROSARIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-375-1130
Mailing Address - Street 1:PO BOX 72018
Mailing Address - Street 2:
Mailing Address - City:CEDARBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53012-7218
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:N54W6135 MILL ST
Practice Address - Street 2:SUITE 600
Practice Address - City:CEDARBURG
Practice Address - State:WI
Practice Address - Zip Code:53012-2021
Practice Address - Country:US
Practice Address - Phone:262-375-1130
Practice Address - Fax:262-375-7006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI20277207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31155600Medicaid
WI000046455Medicare ID - Type Unspecified
WIB52377Medicare UPIN