Provider Demographics
NPI:1689863755
Name:PATRICIO F. VIERNES, M.D. S.C.
Entity Type:Organization
Organization Name:PATRICIO F. VIERNES, M.D. S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIO
Authorized Official - Middle Name:F
Authorized Official - Last Name:VIERNES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-783-5510
Mailing Address - Street 1:13845 W CAPITOL DR
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-2408
Mailing Address - Country:US
Mailing Address - Phone:262-783-5510
Mailing Address - Fax:
Practice Address - Street 1:13845 W CAPITOL DR
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-2408
Practice Address - Country:US
Practice Address - Phone:262-783-5510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-15
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI20487207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty