Provider Demographics
NPI:1487615431
Name:VISAYA, MARIA QUEVADO (MD)
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:QUEVADO
Last Name:VISAYA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIA FE
Other - Middle Name:
Other - Last Name:QUEVADO VISAYA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 735044
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-5044
Mailing Address - Country:US
Mailing Address - Phone:414-529-9200
Mailing Address - Fax:
Practice Address - Street 1:9200 W LOOMIS RD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132-8887
Practice Address - Country:US
Practice Address - Phone:414-529-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI41884020208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32617900Medicaid
WI001301560Medicare ID - Type Unspecified
WI32617900Medicaid