Provider Demographics
NPI:1467401430
Name:PEDRO N BANDA MD SC
Entity Type:Organization
Organization Name:PEDRO N BANDA MD SC
Other - Org Name:CAPITOL ALLERGY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:N
Authorized Official - Last Name:BANDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-442-9166
Mailing Address - Street 1:6030 W CAPITOL DR
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-2118
Mailing Address - Country:US
Mailing Address - Phone:414-442-9166
Mailing Address - Fax:
Practice Address - Street 1:6030 W CAPITOL DR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-2118
Practice Address - Country:US
Practice Address - Phone:414-442-9166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16227207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32857900Medicaid
WI000073652Medicare PIN
WI32857900Medicaid