Provider Demographics
NPI:1669477394
Name:ARCE-GARZON, SANDRA M (MD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:M
Last Name:ARCE-GARZON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:M
Other - Last Name:ARCE-BETANCOURT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4220 S 27TH ST. STE 200
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53221-1855
Mailing Address - Country:US
Mailing Address - Phone:414-282-5810
Mailing Address - Fax:414-282-5468
Practice Address - Street 1:4220 S 27TH ST STE 200
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53221-1855
Practice Address - Country:US
Practice Address - Phone:414-282-5810
Practice Address - Fax:414-282-5468
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI47372208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI7281612OtherAETNA
WI7689455OtherCIGNA
WI2277365OtherCCN
WI34595700Medicaid
WI1200986OtherCOMPCARE/IPN
WI2276529OtherFIRST HEALTH CARE
WI2276529OtherFIRST HEALTH CARE
WI7281612OtherAETNA
WII23542Medicare UPIN
WI0071:01545Medicare PIN
WI2277365OtherCCN