Provider Demographics
NPI:1235146556
Name:JONES, CRESTA WEDEL (MD)
Entity Type:Individual
Prefix:DR
First Name:CRESTA
Middle Name:WEDEL
Last Name:JONES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:DEPT OF OBSTETRICS AND GYNECOLOGY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-805-6600
Mailing Address - Fax:414-805-6622
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:DEPT OF OBSTETRICS AND GYNECOLOGY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-805-6600
Practice Address - Fax:414-805-6622
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VT800888207V00000X
WI51627-20207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02664919OtherNY MEDICAID NUMBER
WI1235146556Medicaid
VT1011594Medicaid
WI1235146556Medicaid
WI736011687Medicare PIN
WI670250207Medicare PIN
VTI38578Medicare UPIN