Healthcare Provider Details

I. General information

NPI: 1881785657
Provider Name (Legal Business Name): JAMES A PUERNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13111 N PORT WASHINGTON ROAD
MEQUON WI
53097
US

IV. Provider business mailing address

4874 N WOODBURN STREET
WHITEFISH BAY WI
53217
US

V. Phone/Fax

Practice location:
  • Phone: 262-243-7423
  • Fax: 262-243-7407
Mailing address:
  • Phone: 414-906-8056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number38934
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: