Provider Demographics
NPI:1730440470
Name:MAXIMO L. CUETO JR. M.D.S.C.
Entity type:Organization
Organization Name:MAXIMO L. CUETO JR. M.D.S.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAXIMO
Authorized Official - Middle Name:LIBRADA
Authorized Official - Last Name:CUETO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:414-282-1152
Mailing Address - Street 1:2745 W LAYTON AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53221-2651
Mailing Address - Country:US
Mailing Address - Phone:414-282-1152
Mailing Address - Fax:414-282-5485
Practice Address - Street 1:2745 W LAYTON AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53221-2651
Practice Address - Country:US
Practice Address - Phone:414-282-1152
Practice Address - Fax:414-282-5485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-30
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI20379-20261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI3010-7800Medicaid
WI000073674OtherMEDICARE
WIB52251Medicare UPIN