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NPI Code Detail

MEDICARE: JILL M BRESNAHAN MD

MEDICARE: JILL M BRESNAHAN MD
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician38803WI

Other Identifiers

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

General Provider Information

NPI Number : 1023064912
Entity Type Code : Individual
Provider Name (Legal Business Name) : JILL M BRESNAHAN MD
Provider Business Mailing Address
First Line : 2524 E WEBSTER PL
Second Line : #301
City : MILWAUKEE
State : WI
Zip : 53211-4256
Country : US
Telephone Number : 414-272-7009
Fax Number : 414-272-6261
Provider Business Practice Location Address
First Line : 2524 E WEBSTER PL
Second Line : #301
City : MILWAUKEE
State : WI
Zip : 53211-4256
Country : US
Telephone Number : 414-272-7009
Fax Number : 414-272-6261
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/25/2006
Last Update Date : 01/18/2011

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Directions to “ JILL M BRESNAHAN MD” Practice Location

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