Provider Demographics
NPI:1851408173
Name:QUEJADA, MARIA ESTELITA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:ESTELITA
Last Name:QUEJADA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIA ESTELITA
Other - Middle Name:F G
Other - Last Name:QUEJADA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6809 122ND AVE
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-7335
Mailing Address - Country:US
Mailing Address - Phone:262-891-6600
Mailing Address - Fax:262-891-6602
Practice Address - Street 1:6809 122ND AVE
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-7335
Practice Address - Country:US
Practice Address - Phone:262-891-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI35105208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32361600Medicaid
BQ3999236OtherDEA NUMBER
WIG16611Medicare UPIN