Provider Demographics
NPI:1962677310
Name:VITOLA, BERNADETTE (MD)
Entity type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:
Last Name:VITOLA
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 1:9000 W WISCONSIN AVE
Mailing Address - Street 2:PEDIATRIC GASTROENTEROLOGY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4874
Mailing Address - Country:US
Mailing Address - Phone:414-266-3690
Mailing Address - Fax:414-266-3676
Practice Address - Street 1:9000 W WISCONSIN AVE
Practice Address - Street 2:PEDIATRIC GASTROENTEROLOGY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-4874
Practice Address - Country:US
Practice Address - Phone:414-266-3690
Practice Address - Fax:414-266-3676
Is Sole Proprietor?:No
Enumeration Date:2008-04-28
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57.0159382080T0004X, 2080T0004X
WI548452080P0206X, 2080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
No2080T0004XAllopathic & Osteopathic PhysiciansPediatricsPediatric Transplant Hepatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1962677310Medicaid
WI075200044Medicare PIN
WI1962677310Medicaid