Provider Demographics
NPI:1033282967
Name:ARAUJO, JOSE G (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:G
Last Name:ARAUJO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2420 S GRAYLOG LN
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-2924
Mailing Address - Country:US
Mailing Address - Phone:262-641-0083
Mailing Address - Fax:262-522-9297
Practice Address - Street 1:11803 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-2077
Practice Address - Country:US
Practice Address - Phone:414-258-5522
Practice Address - Fax:414-258-1337
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI28823207ZP0102X
WI28823-20207QA0401X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI35816000Medicaid
690006345OtherMEDICARE RAILROAD
690006345OtherMEDICARE RAILROAD
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