Provider Demographics
NPI:1568446128
Name:RIQUELME, JEAN MARIE (MD)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:MARIE
Last Name:RIQUELME
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7974 UW HEALTH CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-5531
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 N NINE MOUND RD
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:WI
Practice Address - Zip Code:53593-1032
Practice Address - Country:US
Practice Address - Phone:608-845-9531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI36042-20207Q00000X
ORMD152374207Q00000X
WAMD60319995207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI36042OtherLICENSE
WAMD60319995OtherLICENSE
WI32097700Medicaid
WI000018Medicare Oscar/Certification
WI000127Medicare Oscar/Certification
WIG01327Medicare UPIN
080193994Medicare Oscar/Certification
WI000001Medicare Oscar/Certification
WI36042OtherLICENSE
WI32097700Medicaid
WI000003Medicare Oscar/Certification