Individual provider Active NPI

Nelson Agustin Rodriguez Unda, M.D.

  • Plastic and Reconstructive Surgery Physician
  • Wauwatosa, WI
National Provider Identifier
1346620010
Registry record updated Jul 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X
License
76481 Issued in WI
Practice address
1155 N Mayfair Rd Ste T2600
Wauwatosa, WI 53226-3464
Phone
(414) 955-1000
Fax
(414) 955-0183
NPI assigned
Jun 8, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic and Reconstructive Surgery Physician 2086S0122X 76481 WI Primary

Addresses

Primary practice location

1155 N Mayfair Rd Ste T2600
Wauwatosa, WI 53226-3464

Mailing address

1155 N Mayfair Rd Ste T2600
Wauwatosa, WI 53226-3464
Phone (414) 955-1000

Other identifiers 1

IdentifierTypeStateIssuer
1346620010MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220712001149 WI Practitioner - Plastic and Reconstructive Surgery 1951781699 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Plastic and Reconstructive Surgery
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Medical College of Wisconsin IncGroup PAC ID 2668384371, 2,092 clinicians

Practice addresses (Care Compare)

1155 N Mayfair Rd
FL 2
Milwaukee, WI 53226-3462
Phone (414) 955-4263

8701 W Watertown Plank
Milwaukee, WI 53226-3548
Phone (414) 805-3666

8701 Watertown Plank Rd
Room 4041 MFRC
Milwaukee, WI 53226-3548
Phone (414) 805-3666

W168N11237 Western Ave
Germantown, WI 53022-3239
Phone (262) 253-5060

W180N8000 Town Hall Rd
Menomonee Falls, WI 53051-4002
Phone (262) 255-2500

W180N8085 Town Hall Rd
FL 3
Menomonee Falls, WI 53051-3518
Phone (262) 251-1000

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Mastectomy1-10
Melanoma (skin cancer) excision1-10
Removal of tissue1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
76481WIMDPlastic and Reconstructive Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Froedtert &the Medical College of Wisconsin Community Physicians, Inc. CurrentSince Jul 1, 2023 Accepting new patients
Froedtert &the Medical College of Wisconsin Community Physicians, Inc. CurrentSince Jul 1, 2023 Accepting new patients
The Medical College of Wisconsin, Inc. Surgery CurrentSince Jul 1, 2022 Accepting new patients
The Medical College of Wisconsin Inc Past Accepting new patients

Locations

W168N11237 Western Ave
Germantown, WI 53022
Phone (262) 253-5060

W180N8000 Town Hall Rd
Menomonee Falls, WI 53051
Phone (262) 255-2500

N74W12501 Leatherwood Ct
Menomonee Falls, WI 53051
Phone (414) 454-4744

1155 N Mayfair Rd
Wauwatosa, WI 53226
Phone (414) 955-5990

1155 N Mayfair Rd
Ste T2600
Wauwatosa, WI 53226
Phone (414) 955-1000

8701 Watertown Plank Rd
Wauwatosa, WI 53226
Phone (414) 456-4100

Interoperability endpoints

  • Direct secure messaging: nrodriguez577917@direct.froedtert.com

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1433721600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657756800000",
    "number": "1346620010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1155 N MAYFAIR RD STE T2600",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532263464",
            "telephone_number": "414-955-1000",
            "fax_number": "414-955-0183"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1155 N MAYFAIR RD STE T2600",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532263464",
            "telephone_number": "414-955-1000",
            "fax_number": "414-955-0183"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODRIGUEZ UNDA",
        "first_name": "NELSON",
        "middle_name": "AGUSTIN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-06-08",
        "last_updated": "2022-07-14",
        "certification_date": "2022-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "WI",
            "license": "76481",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1346620010",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wauwatosa, WI

Sources for this page

Verify at the official NPI Registry.