Provider Demographics
NPI:1023250321
Name:VALADARES DE SOUSA, RODRIGO G (MD)
Entity type:Individual
Prefix:
First Name:RODRIGO
Middle Name:G
Last Name:VALADARES DE SOUSA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RODRIGO
Other - Middle Name:G V
Other - Last Name:SOUSA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4225 W. OAKWOOD PARK CT
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132
Mailing Address - Country:US
Mailing Address - Phone:414-435-0025
Mailing Address - Fax:414-435-0026
Practice Address - Street 1:4225 W. OAKWOOD PARK CT
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132
Practice Address - Country:US
Practice Address - Phone:414-435-0025
Practice Address - Fax:414-435-0026
Is Sole Proprietor?:No
Enumeration Date:2009-04-01
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301089777174400000X
WI53122207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
683750505Medicare PIN