MEDICARE: MARQUETTE UNIVERSITY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	1223E0200X	Endodontics
2	1223P0221X	Pediatric Dentistry
3	1223P0300X	Periodontics
4	1223S0112X	Oral and Maxillofacial Surgery (Dentist)
5	1223G0001X	General Practice Dentistry

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013937499
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARQUETTE UNIVERSITY

Provider Business Mailing Address
First Line	:	PO BOX 1881
Second Line	:	SUITE 145 B
City	:	MILWAUKEE
State	:	WI
Zip	:	53201-1881
Country	:	US
Telephone Number	:	414-288-5902
Fax Number	:	414-288-8361

Provider Business Practice Location Address
First Line	:	1801 W WISCONSIN AVE
Second Line	:	SUITE 145 B
City	:	MILWAUKEE
State	:	WI
Zip	:	53233-2186
Country	:	US
Telephone Number	:	414-288-5902
Fax Number	:	414-288-8361

Authorized Official
Title or Position	:	ASSOCIATE DEAN
Name	:	MR. TIMOTHY C CREAMER
Credential	:	DDS
Telephone Number	:	414-288-7485

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	11/01/2016

Similar Medicare Providers

1053278523 — EMILY FISCHER
Practice Location Address:

1801 W WISCONSIN AVE
MILWAUKEE, WI
53233-2186

Practice Phone: 262-720-2666
Practice Fax:

1982693099 — DR. BRIAN DAVID HODGSON DDS
Practice Location Address:

1801 W WISCONSIN AVE
MILWAUKEE, WI
53233-2186

Practice Phone: 414-288-1566
Practice Fax: 414-288-0765

1700851581 — DR. JESSE WAYLON SMITH D.D.S
Practice Location Address:

1801 W WISCONSIN AVE , #206
MILWAUKEE, WI
53233-2186

Practice Phone: 414-288-6508
Practice Fax:

1790743193 — DR. TIMOTHY JOHN CREAMER D.D.S.
Practice Location Address:

1801 W WISCONSIN AVE
MILWAUKEE, WI
53233-2186

Practice Phone: 414-288-6171
Practice Fax:

1164436150 — DR. MOAWIA KASSAB DDS, MS
Practice Location Address:

1801 W WISCONSIN AVE , MARQUETTE UNIVERSITY, DENTAL SCHOOL, SURGICAL SCIENCES
MILWAUKEE, WI
53233-2186

Practice Phone: 414-288-0771
Practice Fax: 414-288-8392

1124032495 — SAMEER RAMBHIA B.D.S., M.S.
Practice Location Address:

1801 W WISCONSIN AVE , #004
MILWAUKEE, WI
53233-2186

Practice Phone: 414-288-5411
Practice Fax:

Directions to “MARQUETTE UNIVERSITY ” Practice Location

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