Provider Demographics
NPI:1609849140
Name:CRISOSTOMO, ARTHUR (MD)
Entity Type:Individual
Prefix:
First Name:ARTHUR
Middle Name:
Last Name:CRISOSTOMO
Suffix:
Gender:M
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:N57W42950 N CORPORATE CIRCLE
Mailing Address - Street 2:PROHEALTH CARE MEDICAL ASSOCIATES INC.
Mailing Address - City:SUSSEX
Mailing Address - State:WI
Mailing Address - Zip Code:53089-4383
Mailing Address - Country:US
Mailing Address - Phone:262-820-3093
Mailing Address - Fax:262-532-9598
Practice Address - Street 1:N57W24950 N CORPORATE CIR
Practice Address - Street 2:PROHEALTH CARE MEDICAL ASSOCIATES INC.
Practice Address - City:SUSSEX
Practice Address - State:WI
Practice Address - Zip Code:53089-4383
Practice Address - Country:US
Practice Address - Phone:262-820-3093
Practice Address - Fax:262-532-9598
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI28637207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30844600Medicaid
683750096Medicare PIN
WI30844600Medicaid