MEDICARE: DR. BRUCE M CAMITTA 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
1	2080P0207X	Pediatric Hematology & Oncology Physician	19850	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	002000111U	OTHER		HUMANA

General Provider Information

NPI Number	:	1881644318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRUCE M CAMITTA MD

Provider Business Mailing Address
First Line	:	9000 W WISCONSIN AVE
Second Line	:	CHILDREN'S HOSPITAL OF WISCONSIN
City	:	MILWAUKEE
State	:	WI
Zip	:	53226-3518
Country	:	US
Telephone Number	:	414-456-4170
Fax Number	:	414-456-6543

Provider Business Practice Location Address
First Line	:	9000 W WISCONSIN AVE
Second Line	:	CHILDREN'S HOSPITAL OF WISCONSIN
City	:	MILWAUKEE
State	:	WI
Zip	:	53226-3518
Country	:	US
Telephone Number	:	414-456-4170
Fax Number	:	414-456-6543

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

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	08/16/2011

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Directions to “ DR. BRUCE M CAMITTA MD” Practice Location

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