MEDICARE: DR. JACOB L BIDWELL 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	207Q00000X	Family Medicine Physician	42673	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

General Provider Information

NPI Number	:	1912916636
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACOB L BIDWELL MD

Provider Business Mailing Address
First Line	:	3301 W FOREST HOME AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53215-2843
Country	:	US
Telephone Number	:	414-647-6326
Fax Number	:	414-671-8860

Provider Business Practice Location Address
First Line	:	1230 GRANT ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53213
Country	:	US
Telephone Number	:	414-286-8892
Fax Number	:	414-384-5578

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

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	03/07/2023

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