Provider Demographics
NPI:1508973850
Name:RICCI, ALBERTINA TOMMASO (DO)
Entity Type:Individual
Prefix:DR
First Name:ALBERTINA
Middle Name:TOMMASO
Last Name:RICCI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:TOMMASO
Other - Last Name:RICCI
Other - Suffix:
Other - Last Name Type:Doing Business As
Other - Credentials:
Mailing Address - Street 1:3301 W FOREST HOME AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-2843
Mailing Address - Country:US
Mailing Address - Phone:414-647-6326
Mailing Address - Fax:414-671-8860
Practice Address - Street 1:2483 CORPORATE CIR
Practice Address - Street 2:
Practice Address - City:EAST TROY
Practice Address - State:WI
Practice Address - Zip Code:53120-2575
Practice Address - Country:US
Practice Address - Phone:262-642-2000
Practice Address - Fax:262-642-2143
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB06798200208000000X
WI49053208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43529400Medicaid