Provider Demographics
NPI:1609821826
Name:TOBAR, ADRIANA (MD)
Entity Type:Individual
Prefix:
First Name:ADRIANA
Middle Name:
Last Name:TOBAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ADRIANA
Other - Middle Name:
Other - Last Name:TOBAR TAYLOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 78866
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53278-8866
Mailing Address - Country:US
Mailing Address - Phone:779-696-7150
Mailing Address - Fax:
Practice Address - Street 1:3505 N BELL SCHOOL RD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61114-6624
Practice Address - Country:US
Practice Address - Phone:779-696-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI53420-020207Q00000X
IL036-115942207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI60974OtherDEAN HEALTH INSURANCE
WI1609821826Medicaid
WI1609821826Medicaid
WIK400112250Medicare PIN