MEDICARE: MR. PAUL EVERETT MITTELSTADT M.D.

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	207P00000X	Emergency Medicine Physician	89106	CA
2	207P00000X	Emergency Medicine Physician	25846	WI

General Provider Information

NPI Number	:	1295725513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PAUL EVERETT MITTELSTADT M.D.

Provider Business Mailing Address
First Line	:	PO BOX 28247
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85285-8247
Country	:	US
Telephone Number	:	480-967-6500
Fax Number	:	480-967-6540

Provider Business Practice Location Address
First Line	:	111 E WISCONSIN AVE STE 2100
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53202-4809
Country	:	US
Telephone Number	:	414-290-6700
Fax Number	:

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

Provider Enumeration Date	:	10/27/2005
Last Update Date	:	03/17/2018

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