Provider Demographics
NPI:1356389258
Name:SOSA, VERONICA N (MD)
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:N
Last Name:SOSA
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 1:2801 W KINNICKINNIC PKWY
Mailing Address - Street 2:SUITE 570
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-3669
Mailing Address - Country:US
Mailing Address - Phone:414-385-8780
Mailing Address - Fax:414-385-8781
Practice Address - Street 1:2801 W KINNICKINNIC PKWY
Practice Address - Street 2:SUITE 570
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-3669
Practice Address - Country:US
Practice Address - Phone:414-385-8780
Practice Address - Fax:414-385-8781
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI47791-0202084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34617600Medicaid
WI34617600Medicaid
WI000301235Medicare PIN