Provider Demographics
NPI:1831302082
Name:MOONEY, COLIN JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:COLIN
Middle Name:JAMES
Last Name:MOONEY
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Gender:M
Credentials:MD
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Mailing Address - Street 1:3200 PLEASANT VALLEY RD
Mailing Address - Street 2:ALYCE & ELMORE KRAEMER CANCER CARE CTR
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095-9274
Mailing Address - Country:US
Mailing Address - Phone:262-836-7200
Mailing Address - Fax:262-836-7201
Practice Address - Street 1:3200 PLEASANT VALLEY RD
Practice Address - Street 2:ALYCE & ELMORE KRAEMER CANCER CARE CTR
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-9274
Practice Address - Country:US
Practice Address - Phone:262-836-7200
Practice Address - Fax:262-836-7201
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2014-01-10
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Provider Licenses
StateLicense IDTaxonomies
WI55900207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1831302082Medicaid
WI680861023Medicare PIN
WI1831302082Medicaid