Provider Demographics
NPI:1093811655
Name:SALUD, ANTONIO DE VILLA II (MD)
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:DE VILLA
Last Name:SALUD
Suffix:II
Gender:M
Credentials:MD
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Mailing Address - Street 1:788 N JEFFERSON ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-3718
Mailing Address - Country:US
Mailing Address - Phone:414-272-8950
Mailing Address - Fax:414-225-2929
Practice Address - Street 1:2323 N LAKE DR
Practice Address - Street 2:ROOM 4250
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-4508
Practice Address - Country:US
Practice Address - Phone:414-291-1468
Practice Address - Fax:414-278-2843
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2016-11-09
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Provider Licenses
StateLicense IDTaxonomies
WI50455207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1093811655Medicaid
WI1093811655Medicaid
WI001946210Medicare PIN