Provider Demographics
NPI:1982658936
Name:PALMA SISTO, PAOLA A (MD)
Entity Type:Individual
Prefix:DR
First Name:PAOLA
Middle Name:A
Last Name:PALMA SISTO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2575 E EVERGREEN DRIVE
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-8904
Mailing Address - Country:US
Mailing Address - Phone:920-969-5353
Mailing Address - Fax:414-337-7201
Practice Address - Street 1:2575 E EVERGREEN DRIVE
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54913-8904
Practice Address - Country:US
Practice Address - Phone:920-969-5353
Practice Address - Fax:414-337-7201
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI421922080P0205X, 2080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
002006261KOtherHUMANA
WI1982658936Medicaid
002006261KOtherHUMANA
002006261KOtherHUMANA