Provider Demographics
NPI:1336112283
Name:SONSALLA, MARY ANN (MD)
Entity Type:Individual
Prefix:
First Name:MARY ANN
Middle Name:
Last Name:SONSALLA
Suffix:
Gender:F
Credentials:MD
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:WAUKESHA HEALTH CARE INC.
Mailing Address - Street 2:N17 W24100 RIVERWOOD DRIVE SUITE 250
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-1177
Mailing Address - Country:US
Mailing Address - Phone:262-928-4100
Mailing Address - Fax:262-928-5835
Practice Address - Street 1:PROHEALTH CARE MEDICAL CENTERS-MUSKEGO
Practice Address - Street 2:S69 W15636 JANESVILLE ROAD
Practice Address - City:MUSKEGO
Practice Address - State:WI
Practice Address - Zip Code:53150
Practice Address - Country:US
Practice Address - Phone:262-928-7000
Practice Address - Fax:414-422-2075
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2009-03-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI40980207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32538400Medicaid
WIG89365Medicare UPIN
WI001168004Medicare PIN