Provider Demographics
NPI:1427053818
Name:MAGLIOCCO, JAMES R (DO)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:R
Last Name:MAGLIOCCO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:JAMES
Other - Middle Name:R
Other - Last Name:MAGLIOCCO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:201 N MAYFAIR RD
Mailing Address - Street 2:STE 505
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4216
Mailing Address - Country:US
Mailing Address - Phone:414-258-7799
Mailing Address - Fax:414-258-9021
Practice Address - Street 1:201 N MAYFAIR RD
Practice Address - Street 2:STE 505
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-4216
Practice Address - Country:US
Practice Address - Phone:414-258-7799
Practice Address - Fax:414-258-9021
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI26680207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30023400Medicaid
WI30023400Medicaid
WIB54756Medicare UPIN