Provider Demographics
NPI:1427099589
Name:GONZALEZ-CERRA, MARIA C (MD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:C
Last Name:GONZALEZ-CERRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9736 N LAMPLIGHTER LN
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-5323
Mailing Address - Country:US
Mailing Address - Phone:715-612-1997
Mailing Address - Fax:
Practice Address - Street 1:9736 N LAMPLIGHTER LN
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-5323
Practice Address - Country:US
Practice Address - Phone:414-358-1321
Practice Address - Fax:715-504-8758
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI42545208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
G86308Medicare UPIN