Provider Demographics
NPI:1386727956
Name:VERZOSA, RAYMUNDO MUNOZ (MD)
Entity type:Individual
Prefix:DR
First Name:RAYMUNDO
Middle Name:MUNOZ
Last Name:VERZOSA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 HAMILTON ST
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:WI
Mailing Address - Zip Code:53901-1200
Mailing Address - Country:US
Mailing Address - Phone:847-650-9274
Mailing Address - Fax:
Practice Address - Street 1:2315 HAMILTON ST
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:WI
Practice Address - Zip Code:53901-1200
Practice Address - Country:US
Practice Address - Phone:847-650-9274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI257540202085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology