Provider Demographics
NPI:1194099101
Name:GUILLERMO D VARONA MD
Entity type:Organization
Organization Name:GUILLERMO D VARONA MD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GUILLERMO
Authorized Official - Middle Name:D
Authorized Official - Last Name:VARONA
Authorized Official - Suffix:
Authorized Official - Credentials:M
Authorized Official - Phone:262-251-9260
Mailing Address - Street 1:N88W16624 APPLETON AVE
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-2858
Mailing Address - Country:US
Mailing Address - Phone:262-251-9260
Mailing Address - Fax:262-251-5844
Practice Address - Street 1:N88W16624 APPLETON AVE
Practice Address - Street 2:
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-2858
Practice Address - Country:US
Practice Address - Phone:262-251-9260
Practice Address - Fax:262-251-5844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-08
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI20708207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000067086Medicare PIN