Provider Demographics
NPI:1649286519
Name:FELIX, JUAN C (MD)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:C
Last Name:FELIX
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 1:9200 W WISCONSIN AVENUE
Mailing Address - Street 2:DEPARTMENT OF PATHOLOGY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-805-3666
Mailing Address - Fax:414-805-6980
Practice Address - Street 1:9200 W WISCONSIN AVENUE
Practice Address - Street 2:DEPARTMENT OF PATHOLOGY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-805-3666
Practice Address - Fax:414-805-6980
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG73369207ZP0102X
WI67502207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALAB28654FMedicaid
CA00G733690OtherBLUE SHIELD
WI1649286519Medicaid
CAP00102816OtherMEDICARE RAILROAD
CA1952325565OtherGROUP NPI
CAD92100Medicare UPIN
CALAB28654FMedicaid