Provider Demographics
NPI:1205843083
Name:QUEJADA-BAYLON, MA REMEDIOS (MD)
Entity Type:Individual
Prefix:
First Name:MA REMEDIOS
Middle Name:
Last Name:QUEJADA-BAYLON
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 1:2425 N 128TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-5233
Mailing Address - Country:US
Mailing Address - Phone:262-352-9081
Mailing Address - Fax:262-938-0227
Practice Address - Street 1:756 N 35TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53208-3360
Practice Address - Country:US
Practice Address - Phone:414-342-2511
Practice Address - Fax:414-342-2209
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI33957208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32185500Medicaid
WI32185500Medicaid