Provider Demographics
NPI:1932948635
Name:MASCARO CARVAJAL, JORGE GILBERTO (MD, FRCS)
Entity type:Individual
Prefix:DR
First Name:JORGE
Middle Name:GILBERTO
Last Name:MASCARO CARVAJAL
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Gender:M
Credentials:MD, FRCS
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Mailing Address - Street 1:9200 W WISCONSIN AVENUE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3222
Mailing Address - Country:US
Mailing Address - Phone:414-955-6900
Mailing Address - Fax:414-955-0079
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:CENTER FOR ADVANCED CARE
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-955-6900
Practice Address - Fax:414-955-0079
Is Sole Proprietor?:No
Enumeration Date:2024-05-22
Last Update Date:2024-05-23
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Provider Licenses
StateLicense IDTaxonomies
WI13-876208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)