Healthcare Provider Details

I. General information

NPI: 1245327485
Provider Name (Legal Business Name): JUAN T BIAGTAN MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2006
Last Update Date: 08/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19475 W NORTH AVE #308
BROOKFIELD WI
53045-4199
US

IV. Provider business mailing address

4555 W SCHROEDER DR #170
MILWAUKEE WI
53223-1475
US

V. Phone/Fax

Practice location:
  • Phone: 262-780-4358
  • Fax: 262-780-4002
Mailing address:
  • Phone: 414-365-3210
  • Fax: 414-365-3225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: JUAN T BIAGTAN
Title or Position: OWNER/PRESIDENT
Credential: MD
Phone: 262-780-4358