Basic Information
| Provider Information | |||||||||
| NPI: | 1811424666 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MADERA ACOSTA | ||||||||
| FirstName: | ADRIA | ||||||||
| MiddleName: | IRINA | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 1ST ST SW | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | MN | ||||||||
| PostalCode: | 559050001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7158385222 | ||||||||
| FaxNumber: | 7067210504 | ||||||||
| Practice Location | |||||||||
| Address1: | 1400 BELLINGER ST # 1400 | ||||||||
| Address2: | |||||||||
| City: | EAU CLAIRE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 547035222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7158385222 | ||||||||
| FaxNumber: | 5132215865 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2017 | ||||||||
| LastUpdateDate: | 08/15/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RR0500X | 76746 | WI | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology |
No ID Information.