Provider Demographics
NPI:1891769865
Name:MONDLOCH, VICTORIA J (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:J
Last Name:MONDLOCH
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:20800 SWENSON DR
Mailing Address - Street 2:SUITE 425
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-2058
Mailing Address - Country:US
Mailing Address - Phone:262-524-9116
Mailing Address - Fax:262-754-4943
Practice Address - Street 1:20800 SWENSON DR
Practice Address - Street 2:SUITE 425
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-2058
Practice Address - Country:US
Practice Address - Phone:262-524-9116
Practice Address - Fax:262-754-4943
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2013-01-17
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Provider Licenses
StateLicense IDTaxonomies
WI26004207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31399000Medicaid
WIB55194Medicare UPIN
WI000146021Medicare PIN