Healthcare Provider Details

I. General information

NPI: 1114066610
Provider Name (Legal Business Name): JEFFREY E TAXMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11501 N PORT WASHINGTON RD G30
MEQUON WI
53092-3465
US

IV. Provider business mailing address

11501 N PORT WASHINGTON RD G30
MEQUON WI
53092-3465
US

V. Phone/Fax

Practice location:
  • Phone: 262-241-8100
  • Fax: 262-241-8200
Mailing address:
  • Phone: 262-241-8100
  • Fax: 262-241-8200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number26227
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: