MEDICARE: DR. PAMELA WILSON HUMES DPM

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
1	213E00000X	Podiatrist	890-025	WI

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
2	P00148211	OTHER	WI	RAILROAD

General Provider Information

NPI Number	:	1104925965
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAMELA WILSON HUMES DPM

Provider Business Mailing Address
First Line	:	4441 N 41ST ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53209-5815
Country	:	US
Telephone Number	:	206-972-9997
Fax Number	:	773-770-0141

Provider Business Practice Location Address
First Line	:	3915 W CAPITOL DR
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-2528
Country	:	US
Telephone Number	:	414-444-9242
Fax Number	:	414-444-9252

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	06/09/2015

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