Healthcare Provider Details

I. General information

NPI: 1568441087
Provider Name (Legal Business Name): EDWARD BUENO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 14TH ST
BARABOO WI
53913-1539
US

IV. Provider business mailing address

707 14TH ST
BARABOO WI
53913-1539
US

V. Phone/Fax

Practice location:
  • Phone: 608-356-1400
  • Fax:
Mailing address:
  • Phone: 608-356-1400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: