Healthcare Provider Details

I. General information

NPI: 1093748493
Provider Name (Legal Business Name): ERNESTO ERFE BUENCAMINO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 06/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6308 8TH AVE SUITE 3090
KENOSHA WI
53143-5031
US

IV. Provider business mailing address

6308 8TH AVE SUITE 3090
KENOSHA WI
53143-5031
US

V. Phone/Fax

Practice location:
  • Phone: 262-658-1678
  • Fax: 262-658-2730
Mailing address:
  • Phone: 262-658-1678
  • Fax: 262-658-2730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20272
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: