Provider Demographics
NPI:1942369269
Name:DEGUZMAN, MARIANO F (MD)
Entity type:Individual
Prefix:
First Name:MARIANO
Middle Name:F
Last Name:DEGUZMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3734 7TH AVENUE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53140
Mailing Address - Country:US
Mailing Address - Phone:262-654-0226
Mailing Address - Fax:262-654-0232
Practice Address - Street 1:3734 7TH AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53140
Practice Address - Country:US
Practice Address - Phone:262-654-0226
Practice Address - Fax:262-654-0232
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WIWI183452080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine