Provider Demographics
NPI:1710597174
Name:VALENZUELA CORTEZ, GUILLERMO MIGUEL (MD)
Entity type:Individual
Prefix:
First Name:GUILLERMO
Middle Name:MIGUEL
Last Name:VALENZUELA CORTEZ
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:PO BOX 249
Mailing Address - Street 2:
Mailing Address - City:FORT ATKINSON
Mailing Address - State:WI
Mailing Address - Zip Code:53538-0249
Mailing Address - Country:US
Mailing Address - Phone:920-563-4466
Mailing Address - Fax:920-568-4004
Practice Address - Street 1:400 DOCTORS CT
Practice Address - Street 2:
Practice Address - City:JOHNSON CREEK
Practice Address - State:WI
Practice Address - Zip Code:53038-9567
Practice Address - Country:US
Practice Address - Phone:920-699-4245
Practice Address - Fax:920-699-4748
Is Sole Proprietor?:No
Enumeration Date:2020-07-31
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT222042207R00000X, 390200000X
WI83885-20207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program