Provider Demographics
NPI:1184660342
Name:PADILLA, JOSE ABRAN (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:ABRAN
Last Name:PADILLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 OAKLEAF WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:ALTOONA
Mailing Address - State:WI
Mailing Address - Zip Code:54720-2245
Mailing Address - Country:US
Mailing Address - Phone:715-832-1400
Mailing Address - Fax:715-832-4187
Practice Address - Street 1:1200 OAKLEAF WAY
Practice Address - Street 2:SUITE A
Practice Address - City:ALTOONA
Practice Address - State:WI
Practice Address - Zip Code:54720-2245
Practice Address - Country:US
Practice Address - Phone:715-832-1400
Practice Address - Fax:715-832-4187
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI48435207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI107813OtherSECURITY HEALTH PLAN
WI09 02319OtherMEDICA/SELECTCARE EC
WI34823300Medicaid
WI09 02322OtherMEDICA/SELECTCARE CF
WI000805130Medicare PIN
WI09 02322OtherMEDICA/SELECTCARE CF
WI000820325Medicare PIN