JONNY ALEXANDER MACIAS TEJADA M.D. NPI 1508075409

NPI Information

NPI: 1508075409
Provider Name: JONNY ALEXANDER MACIAS TEJADA, M.D.
Classification: Internal Medicine - 207RG0300X
Entity Type: Individual

Specialization: Geriatric Medicine

Organization: AURORA MEDICAL GROUP INC

PECOS Registration: Yes

Address:
1020 N 12TH ST STE 301
MILWAUKEE, WI
ZIP 53233
Phone: (414) 219-7300
Get Directions

Jonny Alexander Macias Tejada, M.D. is a geriatric medicine internal medicine in Milwaukee, WI with 22 years of experience. The provider is an internist who has special knowledge of the aging process and special skills in the diagnostic, therapeutic, preventive and rehabilitative aspects of illness in the elderly. This specialist cares for geriatric patients in the patient's home, the office, long-term care settings such as nursing homes and the hospital. Jonny Alexander Macias Tejada, M.D. NPI is 1508075409. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

1020 N 12TH ST STE 301
MILWAUKEE, WI
ZIP 53233-308
Phone: (414) 219-7300
Fax: (414) 219-7632

The NPI 1508075409 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 5/21/2007 and was last updated on 11/24/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207QG0300X	Family Medicine	Geriatric Medicine	52098-020	WISCONSIN	No
2	207RG0300X	Internal Medicine	Geriatric Medicine	52098-020	WISCONSIN	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	100005725	MEDICAID	WISCONSIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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