Healthcare Provider Details

I. General information

NPI: 1154375988
Provider Name (Legal Business Name): STUART E BLACHER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 09/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19333 W NORTH AVE
BROOKFIELD WI
53045-4132
US

IV. Provider business mailing address

19333 W NORTH AVE
BROOKFIELD WI
53045-4132
US

V. Phone/Fax

Practice location:
  • Phone: 414-447-2221
  • Fax: 262-641-6880
Mailing address:
  • Phone: 414-447-2221
  • Fax: 262-641-6880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number24655
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: