Provider Demographics
NPI:1215037155
Name:CAROLINA G. CONTI, M.D., S.C.
Entity Type:Organization
Organization Name:CAROLINA G. CONTI, M.D., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLINA
Authorized Official - Middle Name:G
Authorized Official - Last Name:CONTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-431-2888
Mailing Address - Street 1:756 N 35TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53208-3360
Mailing Address - Country:US
Mailing Address - Phone:414-431-2888
Mailing Address - Fax:414-431-4288
Practice Address - Street 1:756 N 35TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53208-3360
Practice Address - Country:US
Practice Address - Phone:414-431-2888
Practice Address - Fax:414-431-4288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI21275800Medicaid
WI21275800Medicaid