Provider Demographics
NPI:1043228612
Name:ANDRES-PALINES, JESUSA S (MD)
Entity type:Individual
Prefix:DR
First Name:JESUSA
Middle Name:S
Last Name:ANDRES-PALINES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JESUSA
Other - Middle Name:S
Other - Last Name:ANDRES
Other - Suffix:
Other - Last Name Type:Doing Business As
Other - Credentials:
Mailing Address - Street 1:3301 W FOREST HOME AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-2843
Mailing Address - Country:US
Mailing Address - Phone:414-647-6326
Mailing Address - Fax:
Practice Address - Street 1:1881 CHICAGO ST
Practice Address - Street 2:
Practice Address - City:DEPERE
Practice Address - State:WI
Practice Address - Zip Code:54115
Practice Address - Country:US
Practice Address - Phone:920-403-8000
Practice Address - Fax:920-403-8208
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI42973207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
BP4667993OtherDEA NUMBER
G23109Medicare UPIN